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Dental - Virginia

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

Group Size Group Subscriber Enrollment Form Group 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)
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)

Go to Virginia Group Applications and Forms

Ordering Multiple Copies:

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