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
With Waiting Periods
Plan Description
No Waiting Periods (NW)*

* Please see Plan Rules for
information on waiting periods.
Certificate of Coverage
High Option A 

SDBC
High Option A_NW

SDBC
High Option A
High Option A with Ortho

SDBC
High Option A with Ortho_NW

SDBC
 
High Option A D&P

SDBC
HIgh Option A D&P_NW

SDBC
High Option A D&P w Ortho

SDBC
High Option A D&P w Ortho_NW

SDBC
 
     
High Option B 

SDBC
High Option B_NW

SDBC
High Option B
High Option B with Ortho

SDBC
High Option B with Ortho_NW

SDBC
 
High Option B D&P

SDBC
HIgh Option B D&P_NW

SDBC
 
High Option B D&P w Ortho

SDBC
High Option B D&P w Ortho_NW

SDBC
 
     
High Option C 

SDBC
High Option C_NW

SDBC
High Option C
High Option C with Ortho

SDBC
High Option C with Ortho_NW

SDBC
 
High Option C D&P

SDBC
HIgh Option C D&P_NW

SDBC
 
High Option C D&P w Ortho

SDBC
High Option C D&P w Ortho_NW

SDBC
 
     
Premier 2000 Plan 

SDBC
Premier 2000 Plan NW

SDBC
 
Premier 2000 Plan
Premier 2000 with Ortho

SDBC
Premier 2000 with Ortho NW

SDBC
 
Premier 2000 Plan D&P

SDBC
Premier 2000 Plan D&P NW

SDBC
 
Premier 2000 D&P w Ortho

SDBC
Premier 2000 D&P w Ortho NW

SDBC
 
     
Premier 1500 Plan

SDBC
Premier 1500 Plan NW

SDBC
Premier 1500 Plan
Premier 1500 with Ortho

SDBC
Premier 1500 with Ortho NW

SDBC
 
Premier 1500 D&P

SDBC
Premier 1500 D&P NW

SDBC
 
Premier 1500 D&P w Ortho

SDBC
Premier 1500 D&P w Ortho NW

SDBC
 
     
Plan I

SDBC
Plan I NW

SDBC
Plan I
Plan I with Ortho

SDBC
Plan I with Ortho NW

SDBC
 
Plan I D&P

SDBC
Plan I D&P NW

SDBC
 
Plan I D&P w Ortho

SDBC
Plan I D&P w Ortho NW

SDBC
 
     
Plan II

SDBC
Plan II NW

SDBC
Plan II
Plan II with Ortho

SDBC
Plan II with Ortho NW

SDBC
 
     
Plan III

SDBC
Plan III NW

SDBC
Plan III
Plan III w Ortho

SDBC
Plan III w Ortho NW

SDBC
     
Plan IV

SDBC
Plan IV NW

SDBC
Plan IV
     
Choice 2000

SDBC
Choice 2000 NW

SDBC
Choice 2000
Choice 2000 w Ortho

SDBC
Choice 2000 w Ortho NW

SDBC
 
Choice 2000 D&P

SDBC
Choice 2000 D&P NW

SDBC
 
Choice 2000 D&P w Ortho

SDBC
Choice 2000 D&P w Ortho NW

SDBC
 
     
Choice 1500

SDBC
Choice 1500 NW

SDBC
Choice 1500
Choice 1500 with Ortho

SDBC
Choice 1500 with Ortho NW

SDBC
 
Choice 1500 D&P

SDBC
Choice 1500 D&P NW

SDBC
 
Choice 1500 D&P w Ortho

SDBC
Choice 1500 D&P w Ortho NW

SDBC
 
     
PPO+ 2000

SDBC
PPO+ 2000 NW

SDBC
PPO+ 2000
PPO+ 2000 with Ortho

SDBC
PPO+ 2000 with Ortho NW

SDBC
 
PPO+ 2000 D&P

SDBC
PPO+ 2000 D&P NW

SDBC
 
PPO+ 2000 D&P w Ortho

SDBC
PPO+ 2000 D&P w Ortho NW

SDBC
 
     
Option 1

SDBC
Option 1 NW

SDBC
Option 1
Option 1 with Ortho

SDBC
Option 1 with Ortho NW

SDBC
 
Option 1 D&P

SDBC
Option 1 D&P NW

SDBC
 
Option 1 D&P w Ortho

SDBC
Option 1 D&P w Ortho NW

SDBC
 
     
Option 2

SDBC
Option 2 NW

SDBC
Option 2
Option 2 with Ortho

SDBC
Option 2 with Ortho NW

SDBC
 
Option 2 D&P

SDBC
Option 2 D&P NW

SDBC
 
Option 2 D&P w Ortho

SDBC
Option 2 D&P w Ortho NW

SDBC
 
     
Option 3

SDBC
Option 3 NW

SDBC
Option 3
Option 3 with Ortho

SDBC
Option 3 with Ortho NW

SDBC
 
Option 3 D&P

SDBC
Option 3 D&P NW

SDBC
 
Option 3 D&P w Ortho

SDBC
Option 3 D&P w Ortho NW

SDBC
 
     
Classic 1500

SDBC
Classic 1500 NW

SDBC
Classic 1500
Classic 1500 with Ortho

SDBC
Classic 1500 with Ortho NW

SDBC
 
Classic 1500 D&P

SDBC
Classic 1500 D&P NW

SDBC
 
Classic 1500 D&P w Ortho

SDBC
Classic 1500 D&P w Ortho NW

SDBC
 
     
Classic 1000

SDBC
Classic 1000 NW

SDBC
Classic 1000
Classic 1000 D&P

SDBC
Classic 1000 D&P NW

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