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Description
Provider Directory
Forms
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Forms are available for print in .PDF format or you can call for free
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Click On a Plan Below to See its Description
| Dental Plan Comparison for Small Business. |
| HMO - PPO - Indemnity |
| Employer
Forms Small Group Application Dental & Vision Employer Agreement Enrollment Checklist Proprietor Statement Termination Form Employee Forms Employee Enrollment Form Refusal of Coverage Claim Form Cal-cobra ~Cal-Cobra 2-19 employees Cobra ~ Cobra 20+ employees |
Pacificare
Dental 160 Plan Individual
Forms |
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Underwriting Guidelines for all Dental Plans
| Association Indemnity Plan | How
it works Whats covered |
| Association Indemnity
Plan (high option) |
Benefit description |
| HMO Orthodontic Benefits | |
| HMO 910/140 | |
| HMO 920/142 | |
| HMO 930/144 | |
| PPO Orthodontic Benefits | |
| PPO Plan I | |
| PPO Plan II 1000 | |
| PPO Plan II 1500 | |
| PPO Plan III 1000 | |
| PPO Plan III 1500 |
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New PPO plan descriptions effective 9/1/03
| 810 Indemnity | |
| 820 Indemnity | |
| 830 Indemnity | |
| 400 2-9 employees | |
| 400 10-24 employees | |
| 400 25-50 employees | |
| 410 10-24 employees / $1000 max | |
| 410 10-24 employees / $1500 max | |
| 410 25-50 employees | |
| 420 10-50 employees | |
| PPO Benefits Description Contributory | |
| PPO Benefits Description Voluntary |
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Vision Plan Information
| Pacificare Signature Options PPO | |
If you need a free copy of Adobe Acrobat
Reader click
here. c |