DentalandVisionIns.com
Printing Applications, Plan Descriptions and Certificates.
 
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Administration Instructions for Groups

Employee Application/Deletion or Change Form
Please use the Individual application for adding a new employee, deleting an existing
employee or changing dependent status on an existing employee's coverage.

 

COBRA

Cal-COBRA groups will give us the members address upon termination of coverage and we will generate the Cal-COBRA election form and invoice the member directly for the coverage. 

Federal COBRA groups will need to issue a COBRA form upon the qualifying event.  
Click here for an Adobe Acrobat file of the Federal COBRA form.  
Members who extend coverage under Federal COBRA will be invoiced with the group and the individual premium collection is done by the group.

Please follow this link for a definition of Federal COBRA vs. Cal-COBRA and to notify us which COBRA regulations apply to your group.

 

Dental Plan Descriptions & Certificates

Plan Description Plan Description
in Spanish
Certificate
Premier 2000 Plan Premier 2000 Plan Premier 2000 Plan
Premier 2000 Plan with Ortho Premier 2000 Plan with Ortho  
Premier Plan I Premier Plan I Plan I, Premier
Premier Plan I with Ortho Premier Plan I with Ortho  
Premier 1500 Plan Premier 1500 Plan Premier 1500 Plan
Premier 1500 with Ortho Premier 1500 with Ortho  
Premier Plan II Premier Plan II Plan II, Premier
Premier Plan II with Ortho Premier Plan II with Ortho  
Premier Plan III Premier Plan III Plan III, Premier
Premier Plan III with Ortho Premier Plan III with Ortho  
Premier Plan IV Premier Plan IV Plan IV, Premier
PPO + Choice 2000 PPO + Choice 2000 PPO + Choice 2000
PPO + Choice 2000 w Ortho PPO + Choice 2000 w Ortho  
PPO + 2000 PPO + 2000 PPO +_2000
PPO + 2000 with Ortho PPO 2000 + with Ortho  
PPO + Option 1 PPO + Option I PPO + Option I
PPO + Option 1 with Ortho PPO + Option I with Ortho  
PPO + Choice 1500 PPO + Choice 1500 PPO + Choice 1500
PPO + Choice 1500 w Ortho PPO + Choice 1500 w Ortho  
PPO + Option 2 PPO + Option II PPO + Option II
PPO + Option 2 with Ortho PPO + Option II with Ortho  
PPO + Option 3 PPO + Option III PPO + Option III
PPO + Option 3 with Ortho PPO + Option III with Ortho  
PPO Classic 1500 PPO Classic 1500 PPO Classic 1500
PPO Classic 1500 w Ortho PPO Classic 1500 w Ortho  
PPO Classic 1000 PPO Classic 1000 PPO Classic 1000

Vision Plan Descriptions & Certificates

Plan Description  Plan Description
in Spanish
Certificate
VSP Vision A $20/$25 A $20/$25 VSP Vision A $20/$25
VSP Vision A $25 A $25 VSP Vision A $25
VSP Vision A $10 A $10 VSP Vision A $10
VSP Vision A No co-pay A No co-pay VSP Vision A No co-pay
VSP Vision B $10/$25 B $10/$25 VSP Vision B $10/$25
VSP Vision B $25 B $25 VSP Vision B $25
VSP Vision B $10 B $10 VSP Vision B $10
VSP Vision B No co-pay B No co-pay VSP Vision B No co-pay
VSP Vision C $10/$25 C $10/$25 VSP Vision C $10/$25
VSP Vision C $25 C $25 VSP Vision C $25
VSP Vision C $10 C $10 VSP Vision C $10
VSP Vision C No co-pay C No co-pay VSP Vision C No co-pay