Materials, Forms and Documents

Benefit Sheets for SDC Dental Plans Effective 1/1/2025 or later

SDC Small Group Dental Plan 1314 - MAC

SDC Small Group Dental Plan 1314 - UCR

SDC Small Group Dental Plan 1315 - MAC

SDC Small Group Dental Plan 1315 - UCR

SDC Small Group Dental Plan 1316 - MAC

SDC Small Group Dental Plan 1316 - UCR

SDC Small Group Dental Plan 390 - MAC

SDC Small Group Dental Plan 390 - UCR

Benefit Sheets for MedMutual Dental Plans Effective Prior to 1/1/2025

Dental PPO #1 (Employer Sponsored – No Orthodontia)

Dental PPO #1 (Employer Sponsored – With Orthodontia)

Dental PPO #1 (Voluntary – No Orthodontia) 

Dental PPO #2 (Employer Sponsored – No Orthodontia) 

Dental PPO #2 (Employer Sponsored – With Orthodontia) 

Dental PPO #2 (Voluntary – No Orthodontia) 

Dental Value PPO #1 (Employer Sponsored – No Orthodontia) 

Dental Value PPO #1 (Employer Sponsored – With Orthodontia) 

Dental Value PPO #1 (Open Access – No Orthodontia) 

Dental Value PPO #1 (Voluntary – No Orthodontia) 

Dental Value PPO #2 (Employer Sponsored – No Orthodontia) 

Dental Value PPO #2 (Employer Sponsored – With Orthodontia

Dental Value PPO #2 (Open Access – No Orthodontia)

Dental Value PPO #2 (Voluntary – No Orthodontia)

Dental Value PPO #3 (Open Access – No Orthodontia)

Dental Value PPO #3 (Voluntary – No Orthodontia)

Dental PPO #1 (Employer Sponsored – No Orthodontia)

Dental PPO #1 (Employer Sponsored – With Orthodontia)

Dental PPO #1 (Voluntary – No Orthodontia)

Dental PPO #2 (Employer Sponsored – No Orthodontia)

Dental PPO #2 (Employer Sponsored – With Orthodontia)

Dental PPO #2 (Voluntary – No Orthodontia)

Dental Value PPO #1 (Employer Sponsored – No Orthodontia)

Dental Value PPO #1 (Employer Sponsored – With Orthodontia)

Dental Value PPO #1 (Voluntary – No Orthodontia)

Dental Value PPO #2 (Employer Sponsored – No Orthodontia)

Dental Value PPO #2 (Employer Sponsored – With Orthodontia)

Dental Value PPO #2 (Voluntary – No Orthodontia)

Dental Value PPO #3 (Employer Sponsored—No Orthodontia)

Vision Plan

VSP Benefit Highlight Sheet