2021 Plan Details

Note: The documents below are in PDF format and required Acrobat Reader to view.

• 2021 Family Dental HMO Plan Consumer Brochure
• 2021 Family Dental HMO Schedule of Benefits
• 2021 Family Dental HMO Individual Schedule of Benefits - Spanish
• 2021 Family Dental - Individual EOC - Spanish
• 2021 Covered CA Individual EOC
• HIPAA Privacy Notice

2020 Plan Details

Note: The documents below are in PDF format and required Acrobat Reader to view.

• 2020 Family Dental HMO Plan Consumer Brochure
• 2020 Family Dental Select HMO Schedule of Benefits
• 2020 Family Dental Choice HMO Schedule of Benefits
• 2020 Family Dental Select HMO Schedule of Benefits - Spanish
• 2020 Family Dental Choise HMO Schedule of Benefits - Spanish
• 2020 Covered CA Individual EOC
• 2020 Covered CA Individual EOC - Spanish
• HIPAA Privacy Notice

Language Assistance Information - The document supports the following languages: