DentalandVisionIns.com
Printing Applications, Plan Descriptions and Certificates.
  
 Applications    Dental Plans    Vision Plans

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Applications & COBRA Forms
New Employee Application/Deletion or Change Form (Adobe file)
Please use the Individual application for adding a new employee, deleting an existing employee or changing dependent status on an existing employee's coverage.

New Employee Application/Deletion or Change Form (Zipped Microsoft Word)
Administration Instructions for Groups
COBRA Form (Adobe file)
Please use this form to notify us of a COBRA or CAL-COBRA election

COBRA Form (Zipped Microsoft word)

Dental Plan Descriptions & Certificates
Plan Description - Adobe Acrobat File Certificate- Adobe Acrobat File
2000 Plan 2000 Premier Plan
2000 Plan with Ortho  
Plan I Plan I, Premier
Plan I with Ortho  
1500 Plan 1500 Plan, Premier
1500 with Ortho  
Plan II Plan II, Premier
Plan II with Ortho  
Plan III Plan III, Premier
Plan III with Ortho  
Plan IV Plan IV, Premier
PPO Option I PPO Option 1
PPO Option I with Ortho  
PPO Option II PPO Option II
PPO Option II with Ortho  
PPO Option III PPO Option III
PPO Option III with Ortho  

Vision Plan Descriptions & Certificates
Plan Description - Adobe Acrobat File Certificate- Adobe Acrobat File
VSP Vision A $20/$25 co-pay VSP Vision A $20/$25
VSP Vision A $25 co-pay VSP Vision A $25
VSP Vision A $10 co-pay VSP Vision A $10
VSP Vision A No co-pay VSP Vision A No co-pay
VSP Vision B $10/25 co-pay VSP Vision B $10/$25
VSP Vision B $25 co-pay VSP Vision B $25
VSP Vision B $10 co-pay VSP Vision B $10
VSP Vision B No co-pay VSP Vision B No co-pay
VSP Vision C $10/25 co-pay VSP Vision C $10/$25
VSP Vision C $25 co-pay VSP Vision C $25
VSP Vision C $10 co-pay VSP Vision C $10
VSP Vision C No co-pay VSP Vision C No co-pay