Dental - District of Columbia

Freestanding Preferred (PPO), Traditional, BlueDental Plus, BlueDental EPO & 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 EPO
  • BlueDental Basic
  • Preferred Dental
  • Traditional Dental
SUM2709 DC/GHMSI/POE (1/13) (for plans effective prior to 5/1/19)

DC/GHMSI/DN-VS ONLY/GCA (R. 11/18) (for plans effective 5/1/19 and after)
51+ Freestanding
(not certified ACA benchmark plans; benefits include dental services for adults and children)
  • BlueDental Plus
  • BlueDental EPO
  • BlueDental Basic
  • Preferred Dental
  • Traditional Dental
SUM2709 DC/GHMSI/GCA/LG (1/14) (BP, HB(PPO), & DN-VS Only) (for plans effective prior to 5/1/19)

DC/GHMSI/DN-VS ONLY/GCA (R. 11/18) (for plans effective 5/1/19 and after)