Dental - District of Columbia

Freestanding Preferred (PPO), Traditional, BlueDental Plus & BlueDental Basic

Group SizeGroup Subscriber Enrollment FormGroup Contract Application
2-50 (Grandfathered/Non-ACA) CUT5153 N/A
2-50 Freestanding
(ACA-compliant member level rated plans; benefits include dental services for adults and children)
  • BlueDental Preferred
  • BlueDental Traditional
SUM2030 DC/GHMSI/GCA/SG (1/14) (D-V Only)
2-50 Freestanding
(not certified ACA benchmark plans; benefits include dental services for adults and children)
  • BlueDental Plus
  • BlueDental Basic
  • Preferred Dental
  • Traditional Dental
SUM2709 DC/GHMSI/POE (1/13)
51+ Freestanding
(not certified ACA benchmark plans; benefits include dental services for adults and children)
  • BlueDental Plus
  • BlueDental Basic
  • Preferred Dental
  • Traditional Dental
SUM2709 DC/GHMSI/GCA/LG (1/14) (BP, HB(PPO), & DN-VS Only)

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Applications and Forms

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