Dental – Standard

Links, Forms & Helpful Information

• Delta Dental Website 
• Dental Claim Form

Benefit Summaries

• $1,000 Annual Max
• $1,500 Annual Max
• $2,000 Annual Max
• $1,000 Annual Max with Orthodontia
• $1,500 Annual Max with Orthodontia
• $2,000 Annual Max with Orthodontia

Certificates

• $1,000 Annual Max
• $1,500 Annual Max
• $2,000 Annual Max
• $1,000 Annual Max with Orthodontia
• $1,500 Annual Max with Orthodontia
• $2,000 Annual Max with Orthodontia

Vision – Standard

Links, Forms & Helpful Information

• VSP Website
• VSP Provider Lookup
• VSP Out of Network Claim Form
• Eye Med Out of Network Claim Form
• Choice Balance Care – Generic Eye Care Claim Reimbursement Form

Benefit Summaries

• VSP Choice $10/$25
• VSP Choice $10/$0
• Eye Med $10/$25

Certificates

• Choice Balance Care 
• VSP Signature $10/$25
• VSP Signature $10/$0
• Eye Med $10/$25

Ancillary Benefits & Programs

Benefit & Program Summaries

• United Healthcare Life/AD&D Benefit Overview 
• Life/AD&D Benefit Summaries:
  • $10k
  • $20k
  • $30k
  • $40k
  • $50k
• Life/AD&D Certificate (All Increments of Coverage)
• How to File a Life Claim

Forms

• Life Beneficiary Form
• Life Claim Form
• AD&D Claim Form

Flyers & Resources

• LifeBalance Flyer
• LifeBalance Website