Summary of Benefits 2027 - Dental

The following Summary of Benefits (SOB) are for groups of 101 or more employees.

When providing a summary of benefit to an applicant or Blue Shield member, you must also include a Disclosure and a Notice of Language Assistance (PDF, 1 MB).

Smile Spectrum PPO Dental plans

Plan name	Summary of Benefits	Disclosure
Smile^SM Spectrum 50/1000/No Ortho/MAC	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum 50/1000/Ortho/MAC	English (PDF, 255KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum 50/1500/No Ortho/MAC	English (PDF, 253 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum 50/1500/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum 50/1500/Ortho/MAC	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum 50/1500/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/1000/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/1500/Lifetime Ortho 1500/U80	English (PDF, 257 KB) Spanish (Coming soon))	Disclosure (PDF, 747 KB)
SmileSM Spectrum Premier Plus 25/1500/Lifetime Ortho 1500/U80	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/1500/No Ortho/MAC	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/1500/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/1500/Ortho/MAC	English (PDF, 255 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/1500/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/2000/No Ortho/U90	English (PDF, 255 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/2000/Ortho/MAC	English (PDF, 255 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/2000/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier D&P Waiver+Rollover 50/1500/Ortho/U90	English (PDF, 180 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 25/1500/No Ortho/U80	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 25/2000/Lifetime Ortho 1500/U80	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 25/2500/Lifetime Ortho 2000/U90	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 25/2500/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
SmileSM Spectrum Premier Plus 50/1000/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/1000/No Ortho/MAC	English (PDF, 253 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/1000/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/1000/Ortho/MAC	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/1500/No Ortho/MAC	English (PDF, 253 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/1500/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/1500/Ortho/MAC	English (PDF, 255 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/1500/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/2000/No Ortho/MAC	English (PDF, 253 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/2000/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/2000/Ortho/MAC	English (PDF, 255 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/2000/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/2500/Lifetime Ortho 2000/U80	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus Rollover 50/1500/No Ortho/U90	English (PDF, 258 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Rollover 50/1500/No Ortho/U90	English (PDF, 258 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Rollover 50/1500/Ortho/U90	English (PDF, 260 KB) Spanish (Coming soon))	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/2000/Lifetime Ortho 2000/U90	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile℠ Spectrum Premier Plus Rollover 50/1500/Ortho/U90	English (PDF, 260 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/1500/Lifetime Ortho 1500/U90	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/2000/Lifetime Ortho 2000/U90	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/1500/Lifetime Ortho 1500/U90	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/2500/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/2500/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/3000/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/3000/No Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/2500/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/3000/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/2500/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/3000/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/5000/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/5000/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/5000/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SMSpectrum Premier Plus 50/5000/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)

Not Marketed Smile Spectrum PPO Dental plans

Plan name	Benefit Summary / SOB	Disclosure
Smile^SM Spectrum Premier 50/1000/No Ortho/U90	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/2000/Lifetime Ortho 1500/U80	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier 50/2000/No Ortho/MAC	English (PDF, 254 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier D&P Waiver 50/1500/Ortho/U90	English (PDF, 256 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Premier Plus 50/3000/Lifetime Ortho 2000/U80	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)
Smile^SM Spectrum Advantage 50/2000/Ortho/U80	English (PDF, 257 KB) Spanish (Coming soon)	Disclosure (PDF, 747 KB)

Dental HMO plans

Plan name	Summary of Benefits	Disclosure
Dental HMO Basic	English (PDF, 318 KB) Spanish (Coming soon)	Disclosure (PDF, 745 KB)
Dental HMO Standard	English (PDF, 318 KB) Spanish (Coming soon)	Disclosure (PDF, 745 KB)
Dental HMO Plus	English (PDF, 318 KB) Spanish (Coming soon)	Disclosure (PDF, 745 KB)
Dental HMO Deluxe	English (PDF, 318 KB) Spanish (Coming soon)	Disclosure (PDF, 745 KB)
Dental HMO Elite 75	English (PDF, 328 KB) Spanish (Coming soon)	Disclosure (PDF, 745 KB)
Dental HMO Elite 100	English (PDF, 328 KB) Spanish (Coming soon)	Disclosure (PDF, 745 KB)

Dental INO plans

Plan name	Summary of Benefits	Disclosure
Smile^SM D&P In-Network Only Dental PPO	English (PDF, 228 KB) Spanish (Coming soon)	Disclosure (PDF, 757 KB)
Smile^SM Dental In-Network Only (DINO) 50/2000/Lifetime Ortho 2000	English (PDF, 225 KB) Spanish (Coming soon)	Disclosure (PDF, 757 KB)
Smile^SM Dental In-Network Only (DINO) 50/1500/Lifetime Ortho 1500	English (PDF, 225 KB) Spanish (Coming soon)	Disclosure (PDF, 757 KB)
Smile^SM Dental In-Network Only (DINO) 50/2000/No Ortho	English (PDF, 241 KB) Spanish (Coming soon)	Disclosure (PDF, 757 KB)
Smile^SM Dental In-Network Only (DINO) 50/1500/No Ortho	English (PDF, 241 KB) Spanish (Coming soon)	Disclosure (PDF, 757 KB)

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