DentalandVisionIns.com


Administration Instructions for Groups
Employee Application/Deletion or Change Form
VSP information is on the bottom of the page.

Plan Descriptions,
Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC)
and Certificates.


For descriptions in a language other than English, please have the member create a login at DeltaDentalins.com
Plan Description
Effective 01-01-2025 there are no more waiting periods on our plans.
Certificate of Coverage
High Option A

SDBC
High Option A
High Option A with Ortho

SDBC
 
HIgh Option A D&P

SDBC
High Option A D&P w Ortho

SDBC
 
   
High Option B

SDBC
High Option B
High Option B with Ortho

SDBC
 
HIgh Option B D&P

SDBC
 
High Option B D&P w Ortho

SDBC
 
   
High Option C

SDBC
High Option C
High Option C with Ortho

SDBC
 
HIgh Option C D&P

SDBC
 
High Option C D&P w Ortho

SDBC
 
   
Premier 2000 Plan

SDBC
 
Premier 2000 Plan
Premier 2000 with Ortho

SDBC
 
Premier 2000 Plan D&P

SDBC
 
Premier 2000 D&P w Ortho

SDBC
 
   
Premier 1500 Plan

SDBC
Premier 1500 Plan
Premier 1500 with Ortho

SDBC
 
Premier 1500 D&P

SDBC
 
Premier 1500 D&P w Ortho

SDBC
 
   
Plan I

SDBC
Plan I
Plan I with Ortho

SDBC
 
Plan I D&P

SDBC
 
Plan I D&P w Ortho

SDBC
 
   
Plan II

SDBC
Plan II
Plan II with Ortho

SDBC
 
   
Plan III

SDBC
Plan III
Plan III w Ortho

SDBC
   
Plan IV

SDBC
Plan IV
   
Choice 2000

SDBC
Choice 2000
Choice 2000 w Ortho

SDBC
 
Choice 2000 D&P

SDBC
 
Choice 2000 D&P w Ortho

SDBC
 
   
Choice 1500

SDBC
Choice 1500
Choice 1500 with Ortho

SDBC
 
Choice 1500 D&P

SDBC
 
Choice 1500 D&P w Ortho

SDBC
 
   
PPO+ 2000

SDBC
PPO+ 2000
PPO+ 2000 with Ortho

SDBC
 
PPO+ 2000 D&P

SDBC
 
PPO+ 2000 D&P w Ortho

SDBC
 
   
Option 1

SDBC
Option 1
Option 1 with Ortho

SDBC
 
Option 1 D&P

SDBC
 
Option 1 D&P w Ortho

SDBC
 
   
Option 2

SDBC
Option 2
Option 2 with Ortho

SDBC
 
Option 2 D&P

SDBC
 
Option 2 D&P w Ortho

SDBC
 
   
Option 3

SDBC
Option 3
Option 3 with Ortho

SDBC
 
Option 3 D&P

SDBC
 
Option 3 D&P w Ortho

SDBC
 
   
Classic 1500

SDBC
Classic 1500
Classic 1500 with Ortho

SDBC
 
Classic 1500 D&P

SDBC
 
Classic 1500 D&P w Ortho

SDBC
 
   
Classic 1000

SDBC
Classic 1000
Classic 1000 D&P

SDBC
 

 




For descriptions in a language other than English, please have the member create a login at VSP.com.
Plan Descriptions Certificate of Coverage
VSP A $20/25 VSP A $20/25
VSP A $25 VSP A $25
VSP A $10 VSP A $10
VSP A No Co-pay VSP A No Co-pay
VSP B $10/$25 VSP B $10/$25
VSP B $25 VSP B $25
VSP B $10 VSP B $10
VSP B No Co-pay VSP B No Co-pay
   
VSP C $10/$25 VSP C $10/$25
VSP C $25 VSP C $25
VSP C $10 VSP C $10
VSP C $5 High Option VSP C $5 High Option
VSP C No Co-pay VSP C No Co-pay