Materials, Forms and Documents

Dental Plans

Dental PPO #1 (Employer Sponsored – No Orthodontia)

Dental PPO #1 (Employer Sponsored – With Orthodontia)

Dental PPO #1 (Voluntary – No Orthodontia) 

Dental PPO #2 (Employer Sponsored – No Orthodontia) 

Dental PPO #2 (Employer Sponsored – With Orthodontia) 

Dental PPO #2 (Voluntary – No Orthodontia) 

Dental Value PPO #1 (Employer Sponsored – No Orthodontia) 

Dental Value PPO #1 (Employer Sponsored – With Orthodontia) 

Dental Value PPO #1 (Open Access – No Orthodontia) 

Dental Value PPO #1 (Voluntary – No Orthodontia) 

Dental Value PPO #2 (Employer Sponsored – No Orthodontia) 

Dental Value PPO #2 (Employer Sponsored – With Orthodontia

Dental Value PPO #2 (Open Access – No Orthodontia)

Dental Value PPO #2 (Voluntary – No Orthodontia)

Dental Value PPO #3 (Open Access – No Orthodontia)

Dental Value PPO #3 (Voluntary – No Orthodontia)

Dental PPO #1 (Employer Sponsored – No Orthodontia)

Dental PPO #1 (Employer Sponsored – With Orthodontia)

Dental PPO #1 (Voluntary – No Orthodontia)

Dental PPO #2 (Employer Sponsored – No Orthodontia)

Dental PPO #2 (Employer Sponsored – With Orthodontia)

Dental PPO #2 (Voluntary – No Orthodontia)

Dental Value PPO #1 (Employer Sponsored – No Orthodontia)

Dental Value PPO #1 (Employer Sponsored – With Orthodontia)

Dental Value PPO #1 (Voluntary – No Orthodontia)

Dental Value PPO #2 (Employer Sponsored – No Orthodontia)

Dental Value PPO #2 (Employer Sponsored – With Orthodontia)

Dental Value PPO #2 (Voluntary – No Orthodontia)

Dental Value PPO #3 (Employer Sponsored—No Orthodontia)

Vision Plan

VSP Benefit Highlight Sheet

CLE-Care HMO Plans

CLE Care 3020-250 Rx

CLE Care 3020-1000 Rx

CLE Care 3020-2000 Rx

CLE Care HSA 5000 PDRx

Copay Plans

Copay 3020-250 Rx

Copay 020-3000 Rx

Copay 020-5000 Rx

Copay 30-1000 Rx

Copay 30-2000 Rx

Copay 30-3500 Rx

Copay 30-5000 Rx

Copay 30-8000 Rx

Copay 2530-3000 Rx

Copay 2530-4000 Rx

Copay 3020-500 Rx

Copay 3020-1000 Rx

Copay 3020-1500 Rx

Copay 3020-2000 Rx

Copay 3020-3000 Rx

Copay 3020-6000 Rx

Copay 8700 MMRx

HRA Plans

HRA 30-2000 Rx

HRA 30-3500 Rx

HRA 6500 MMRx

HSA Plans

HSA 2500 MMRx

HSA 3000 PDRx SHARE

HSA 3000 PDRx

HSA 3000-30 PDRx

HSA 4000 PDRx

HSA 4000-20 MMRx

HSA 5000 PDRx SHARE

HSA 5000 PDRx

HSA 6550 MMRx

MedFlex Plans

MedFlex 3020-250 Rx

MedFlex 3020-1000 Rx

MedFlex 3020-2000 Rx

MedFlex HSA 5000 PDRx

Share Plans

SHARE 3020-1000 Rx

SHARE 3020-1500 Rx

SHARE 3020-2000 Rx

SHARE 3020-3000 Rx

Dental Plans

Dental PPO #1 (Employer Sponsored – No Orthodontia)

Dental PPO #1 (Employer Sponsored – With Orthodontia)

Dental PPO #1 (Voluntary – No Orthodontia) 

Dental PPO #2 (Employer Sponsored – No Orthodontia) 

Dental PPO #2 (Employer Sponsored – With Orthodontia) 

Dental PPO #2 (Voluntary – No Orthodontia) 

Dental Value PPO #1 (Employer Sponsored – No Orthodontia) 

Dental Value PPO #1 (Employer Sponsored – With Orthodontia) 

Dental Value PPO #1 (Open Access – No Orthodontia) 

Dental Value PPO #1 (Voluntary – No Orthodontia) 

Dental Value PPO #2 (Employer Sponsored – No Orthodontia) 

Dental Value PPO #2 (Employer Sponsored – With Orthodontia

Dental Value PPO #2 (Open Access – No Orthodontia)

Dental Value PPO #2 (Voluntary – No Orthodontia)

Dental Value PPO #3 (Open Access – No Orthodontia)

Dental Value PPO #3 (Voluntary – No Orthodontia)

Dental PPO #1 (Employer Sponsored – No Orthodontia)

Dental PPO #1 (Employer Sponsored – With Orthodontia)

Dental PPO #1 (Voluntary – No Orthodontia)

Dental PPO #2 (Employer Sponsored – No Orthodontia)

Dental PPO #2 (Employer Sponsored – With Orthodontia)

Dental PPO #2 (Voluntary – No Orthodontia)

Dental Value PPO #1 (Employer Sponsored – No Orthodontia)

Dental Value PPO #1 (Employer Sponsored – With Orthodontia)

Dental Value PPO #1 (Voluntary – No Orthodontia)

Dental Value PPO #2 (Employer Sponsored – No Orthodontia)

Dental Value PPO #2 (Employer Sponsored – With Orthodontia)

Dental Value PPO #2 (Voluntary – No Orthodontia)

Dental Value PPO #3 (Employer Sponsored—No Orthodontia)

Vision Plan

VSP Benefit Highlight Sheet