Forms & Documents

Summary of Benefits (SOB)

Dental PPO w/Ortho: Delta Dental

	PPO Plus Premier Deluxe 200 | $3000 Max | D&P Max Waiver | $1500 Child Ortho SOB
	PPO Plus Premier Deluxe 200 Voluntary | $1500 Max | $1500 Child and Adult Ortho SOB
	PPO Plus Premier Deluxe 200 Voluntary | $1500 Max | $1500 Child Ortho SOB
	PPO Plus Premier Deluxe 200 Voluntary | $2000 Max | $1500 Child and Adult Ortho SOB
	PPO Plus Premier Deluxe 200 Voluntary | $2000 Max | $1500 Child Ortho SOB
	PPO Plus Premier Deluxe 200 Voluntary | $2500 Max | $1500 Child and Adult Ortho SOB
	PPO Plus Premier Deluxe 200 Voluntary | $2500 Max | $1500 Child Ortho SOB
	PPO Plus Premier Deluxe 200 Voluntary | $3000 Max | $1500 Child and Adult Ortho SOB
	PPO Plus Premier Deluxe 200 Voluntary | $3000 Max | $1500 Child Ortho SOB
	PPO Plus Premier Deluxe 200 Voluntary | $3000 Max SOB
	PPO Plus Premier Dual Choice 2 | $1500 Max | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 2 | $1500 Max | D&P Max Waiver | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 2 | $2000 Max | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 2 | $2000 Max | D&P Max Waiver | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 2 Voluntary | $1500 Max | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 2 Voluntary | $2000 Max | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 3 High | $1500 Max | $1500 Ortho SOB
	PPO Plus Premier Dual Choice 3 High | $1500 Max | D&P Max Waiver | $1500 Ortho SOB
	PPO Plus Premier Dual Choice 3 High | $2500 Max | $1500 Ortho SOB
	PPO Plus Premier Dual Choice 3 High | $2500 Max | D&P Max Waiver | $1500 Ortho SOB
	PPO Plus Premier Dual Choice 3 Low | $1000 Max | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 3 Low | $1000 Max | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 3 Low | $1000 Max | D&P Max Waiver | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 3 Low | $1500 Max | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 3 Low | $1500 Max | D&P Max Waiver | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 3 Voluntary | $1000 Max | $100 Ortho SOB - needs to be $1000 ortho
	PPO Plus Premier Dual Choice 3 Voluntary | $1500 Max | $1000 Ortho SOB
	PPO Plus Premier Dual Choice 3 Voluntary | $1500 Max | $1500 Ortho SOB
	PPO Plus Premier Dual Choice 3 Voluntary | $2500 Max | $1500 Ortho SOB
	PPO Plus Premier Dual Choice Buy-up | $1500 Max | $1500 Ortho SOB
	PPO Plus Premier Dual Choice Buy-up | $2000 Max | $1500 Ortho SOB
	PPO Plus Premier Dual Choice Core | $1000 Max | $1000 Ortho SOB

Dental PPO: Delta Dental

	Choice PPO $1,500 without Ortho Plan Highlights
	Choice Premier $1,000 without Ortho Evidence of Coverage
	Choice Premier $1,000 without Ortho Evidence of Coverage
	Choice Premier $1,000 without Ortho Plan Highlights
	Choice Premier $1,500 without Ortho Evidence of Coverage
	Choice Premier $1,500 without Ortho Evidence of Coverage
	Choice Premier $1,500 without Ortho Plan Highlights
	Choice Premier $2,000 without Ortho Evidence of Coverage
	Choice Premier $2,000 without Ortho Evidence of Coverage
	Choice Premier $2,000 without Ortho Plan Highlights
	CoPower ONE Benefit Highlights Voluntary Plan No Ortho
	CoPower ONE Best Plan Highlights w/$100K Life - New York
	CoPower ONE Best Plan Highlights w/$150K Life - New York
	CoPower ONE Best Plan Highlights w/$25K Life - New York
	CoPower ONE Best Plan Highlights w/$35K Life - New York
	CoPower ONE Best Plan Highlights w/$50K Life - New York
	CoPower ONE Better Plan Highlights w/$100K Life - New York
	CoPower ONE Better Plan Highlights w/$150K Life - New York
	CoPower ONE Better Plan Highlights w/$20K Life - New York
	CoPower ONE Better Plan Highlights w/$35K Life - New York
	CoPower ONE Better Plan Highlights w/$50K Life - New York
	CoPower ONE Better Plus Plan Highlights w/$100K Life - New York
	CoPower ONE Better Plus Plan Highlights w/$150K Life - New York
	CoPower ONE Better Plus Plan Highlights w/$20K Life - New York
	CoPower ONE Better Plus Plan Highlights w/$35K Life - New York
	CoPower ONE Better Plus Plan Highlights w/$50K Life - New York
	CoPower ONE Bronze Plan Highlights w/$100K Life
	CoPower ONE Bronze Plan Highlights w/$150K Life
	CoPower ONE Bronze Plan Highlights w/$15K Life
	CoPower ONE Bronze Plan Highlights w/$35K Life
	CoPower ONE Bronze Plan Highlights w/$50K Life
	CoPower ONE Gold Plan Highlights w/$100K Life
	CoPower ONE Gold Plan Highlights w/$150K Life
	CoPower ONE Gold Plan Highlights w/$20K Life
	CoPower ONE Gold Plan Highlights w/$35K Life
	CoPower ONE Gold Plan Highlights w/$50K Life
	CoPower ONE Good Plan Highlights w/$100K Life - New York
	CoPower ONE Good Plan Highlights w/$150K Life - New York
	CoPower ONE Good Plan Highlights w/$15K Life - New York
	CoPower ONE Good Plan Highlights w/$35K Life - New York
	CoPower ONE Good Plan Highlights w/$50K Life - New York
	CoPower ONE Highlights Voluntary Plan
	CoPower ONE Platinum Plan Highlights w/$100K Life
	CoPower ONE Platinum Plan Highlights w/$150K Life
	CoPower ONE Platinum Plan Highlights w/$25K Life
	CoPower ONE Platinum Plan Highlights w/$35K Life
	CoPower ONE Platinum Plan Highlights w/$50K Life
	CoPower ONE Silver Plan Highlights w/$100K Life
	CoPower ONE Silver Plan Highlights w/$150K Life
	CoPower ONE Silver Plan Highlights w/$20K Life
	CoPower ONE Silver Plan Highlights w/$35K Life
	CoPower ONE Silver Plan Highlights w/$50K Life
	CoPower ONE Voluntary Plan Highlights MBP No Ortho - New York
	CoPower ONE Voluntary Plan Highlights MBP w/Ortho - New York
	CoPower ONE Voluntary Plan Highlights Without Ortho
	PPO Advantage 400 | $1000 Max | D&P Max Waiver SOB
	PPO Advantage 400 | $1000 Max SOB
	PPO Advantage 400 | $1500 Max | D&P Max Waiver SOB
	PPO Advantage 400 | $1500 Max SOB
	PPO Advantage 400 | $2000 Max | D&P Max Waiver SOB
	PPO Advantage 400 | $2000 Max SOB
	PPO Advantage 400 | $2500 Max | D&P Max Waiver SOB
	PPO Advantage 400 | $2500 Max SOB
	PPO Advantage 400 Voluntary | $1000 Max SOB
	PPO Advantage 400 Voluntary | $1500 Max SOB
	PPO Advantage 400 Voluntary | $2000 Max SOB
	PPO Advantage 400 Voluntary | $2500 Max SOB
	PPO Core 100 | $1000 Max SOB