Forms & Documents

Summary of Benefits (SOB)

Dental PPO: Delta Dental

	PPO Plus Premier Dual Choice 3 Voluntary | $1000 Max SOB
	PPO Plus Premier Dual Choice 3 Voluntary | $1500 Max SOB
	PPO Plus Premier Dual Choice 3 Voluntary | $2500 Max SOB
	PPO Plus Premier Dual Choice Buy-up | $1500 Max SOB
	PPO Plus Premier Dual Choice Buy-up | $2000 Max SOB
	PPO Plus Premier Dual Choice Core | $1000 Max SOB

Life: Unum

Unum Group Term Life Plan Highlights

LTD: Unum

	Unum LTD Benefit Summary 10-Life+ 180 Day EP
	Unum LTD Benefit Summary 10-Life+ 360 Day EP
	Unum LTD Benefit Summary 10-Life+ 90 Day EP

Vision: VSP

	CoPower VSP EasyOptions Plan Summary
	VSP Basic Choice Enhanced Plan B $130, $25 with Retail
	VSP Basic Choice Plan A $20 with Retail
	VSP Choice Plan A $20
	VSP Choice Plan A $25 $25
	VSP Choice Plan A $25 $25 with Retail
	VSP Choice Plan B $150 $20 $20
	VSP Choice Plan B $180 $10
	VSP Choice Plan C $150 $10 $25
	VSP Choice Plan C $180 $10
	VSP Choice Plan C $200 $300 $10 $25 EZO
	VSP Easy Option 5 Choice Plan C $10 $25
	VSP Elite Choice Enhanced Plan B $25 with Retail
	VSP Elite Choice Plan C $25 with Retail
	VSP Signature Enhanced Plan B $0 $20
	VSP Signature Enhanced Plan B $0 $20 with Retail
	VSP Signature Enhanced Plan B $25
	VSP Signature Plan A $25
	VSP Signature Plan A $25 with Retail
	VSP Signature Plan C $0 $20
	VSP Signature Plan C $0 $20 with Retail
	VSP Signature Plan C $10
	VSP Signature Plan C $10 with Retail
	VSP Standard Choice Plan C $130, $25 with Retail
	VSP Standard Signature Health Plan B $25 with Retail
	VSP Vol Choice Enhanced Plan B $150, $10 $25 with Retail
	VSP Vol Choice Enhanced Plan B $180, $10 $25 with Retail
	VSP Vol Choice Enhanced Plan B $20 $20
	VSP Vol Choice Enhanced Plan B $20 $20 with Retail
	VSP Vol Choice Plan C $10 $25 with Retail
	VSP Vol Choice Plan C $20 $20 with Retail
	VSP Vol Choice Plan C $25 with Retail
	VSP Vol Easy Options 5 Choice Plan C $10 $25
	VSP Vol Signature Enhanced Health Plan B $10
	VSP Vol Signature Enhanced Health Plan B $10 with Retail
	VSP Vol Signature Plan C $10
	VSP Vol Signature Plan C $10 with Retail