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Dental - Virginia
Freestanding Preferred (PPO), Traditional, BlueDental Plus, BlueDental EPO & 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 (not certified ACA benchmark plans; benefits include dental services for adults and children)
|
SUM2710
(also used for 1-50 VA groups that need to enroll in dental and/or vision benefits) |
VA/GHMSI/POE (1/13) (for plans effective prior to 5/1/19) VA/GHMSI/DN-VS ONLY/GCA (11/18) (for plans effective 5/1/19 and after) |
| 51+ Freestanding (not certified ACA benchmark plans; benefits include dental services for adults and children)
|
SUM2710 | VA/GHMSI/GCA/LG (1/14) (BP, HB(PPO), & DN-VS Only) (for plans effective prior to 5/1/19) VA/GHMSI/DN-VS ONLY/GCA (11/18) (for plans effective 5/1/19 and after) |