Dental - Virginia

Freestanding Preferred (PPO), Traditional, BlueDental Plus & BlueDental Basic

Group SizeGroup Subscriber Enrollment FormGroup Contract Application
2-50
(Grandfathered/Non-ACA; product other than VA E&S)		 CUT5150 N/A
2-50 Freestanding
(ACA-compliant member level rated plans; benefits include dental services for adults and children)
  • BlueDental Preferred
  • BlueDental Traditional
 SUM2031 VA/GRPAPP/HCR (1/14) (D-V Only) (for dental plans effective between 1/1/14 and 12/31/18)

VA/GRPAPP/HCR (1/19) (D-V Only) (for dental plans effective 1/1/19 and after)
2-50 Freestanding
(not certified ACA benchmark plans; benefits include dental services for adults and children)
  • BlueDental Plus
  • BlueDental Basic
  • Preferred Dental
  • Traditional Dental
 SUM2710 VA/GHMSI/POE (1/13)
51+ Freestanding
(not certified ACA benchmark plans; benefits include dental services for adults and children)
  • BlueDental Plus
  • BlueDental Basic
  • Preferred Dental
  • Traditional Dental
 SUM2710 VA/GHMSI/GCA/LG (1/14) (BP, HB(PPO), & DN-VS Only)