Humana Specialty dental and vision benefit forms

Advantage Plus Dental by state

Some states may be limited in plan availability by county.

Florida, Indiana, Missouri, Tennessee

Advantage Plus 1D Plan with Ortho pdf opens in new window

Advantage Plus 1D Plan pdf opens in new window

Advantage Plus 2D Plan with Ortho pdf opens in new window

Advantage Plus 2D Plan pdf opens in new window

Advantage Plus 3D Plan with Ortho pdf opens in new window

Advantage Plus 3D Plan pdf opens in new window

Advantage Plus 4D Plan with Ortho pdf opens in new window

Advantage Plus 4D Plan pdf opens in new window

Advantage Plus 5D Plan pdf opens in new window

Advantage Plus 1S Plan pdf opens in new window

Advantage Plus 2S Plan with Ortho pdf opens in new window

Advantage Plus 3S Plan with Ortho  pdf opens in new window

Advantage Plus 4S Plan pdf opens in new window

Illinois, Kansas, Kentucky

Advantage Plus 1D Plan with Ortho pdf opens in new window

Advantage Plus 1D Plan pdf opens in new window

Advantage Plus 2D Plan with Ortho pdf opens in new window

Advantage Plus 2D Plan pdf opens in new window

Advantage Plus 3D Plan with Ortho pdf opens in new window

Advantage Plus 3D Plan pdf opens in new window

Advantage Plus 4D Plan with Ortho pdf opens in new window

Advantage Plus 4D Plan pdf opens in new window

Advantage Plus 5D Plan pdf opens in new window

Advantage Plus 1S Plan pdf opens in new window

Advantage Plus 2S Plan with Ortho  pdf opens in new window

Advantage Plus 3S Plan with Ortho pdf opens in new window

Advantage Plus 4S Plan pdf opens in new window

Michigan

Advantage Plus 1D Plan with Ortho pdf opens in new window

Advantage Plus 1D Plan pdf opens in new window

Advantage Plus 2D Plan with Ortho  pdf opens in new window

Advantage Plus 2D Plan pdf opens in new window

Advantage Plus 3D Plan with Ortho pdf opens in new window

Advantage Plus 3D Plan pdf opens in new window

Advantage Plus 4D Plan with Ortho pdf opens in new window

Advantage Plus 4D Plan pdf opens in new window

Advantage Plus 5D Plan pdf opens in new window

Advantage Plus 1S Plan with Ortho pdf opens in new window

Advantage Plus 1S Plan pdf opens in new window

Advantage Plus 2S Plan with Ortho pdf opens in new window

Advantage Plus 2S Plan pdf opens in new window

Advantage Plus 3S Plan with Ortho pdf opens in new window

Advantage Plus 3S Plan pdf opens in new window

Advantage Plus 4S Plan with Ortho pdf opens in new window

Advantage Plus 4S Plan pdf opens in new window

Texas

Advantage Plus 1D Plan with Ortho pdf opens in new window

Advantage Plus 2D Plan with Ortho pdf opens in new window

Advantage Plus 3D Plan with Ortho  pdf opens in new window

Advantage Plus 4D Plan with Ortho  pdf opens in new window

Advantage Plus 5D Plan pdf opens in new window

Advantage Plus 1S Plan  pdf opens in new window

Advantage Plus 2S Plan with Ortho pdf opens in new window

Advantage Plus 3S Plan with Ortho  pdf opens in new window

Advantage Plus 4S Plan  pdf opens in new window

Utah

Advantage Plus 1D Plan pdf opens in new window

Advantage Plus 2D Plan pdf opens in new window

Advantage Plus 3D Plan pdf opens in new window

Advantage Plus 4D Plan  pdf opens in new window

Advantage Plus 5D Plan pdf opens in new window

Advantage Plus 1S Plan pdf opens in new window

Advantage Plus 2S Plan with Ortho pdf opens in new window

Advantage Plus 3S Plan with Ortho  pdf opens in new window

Advantage Plus 4S Plan  pdf opens in new window

Wisconsin

Advantage Plus 1D Plan with Ortho pdf opens in new window

Advantage Plus 1D Plan pdf opens in new window

Advantage Plus 2D Plan with Ortho pdf opens in new window

Advantage plus 2D Plan pdf opens in new window

Advantage plus 3D Plan with Ortho pdf opens in new window

Advantage Plus 3D Plan pdf opens in new window

Advantage Plus 4D Plan with Ortho pdf opens in new window

Advantage Plus 4D Plan pdf opens in new window

Advantage Plus 5D Plan pdf opens in new window

Advantage Plus 1S Plan with Ortho pdf opens in new window

Advantage Plus 1S Plan pdf opens in new window

Advantage Plus 2S Plan with Ortho pdf opens in new window

Advantage Plus 2S Plan pdf opens in new window

Advantage Plus 3S Plan with Ortho pdf opens in new window

Advantage Plus 3S Plan  pdf opens in new window

Advantage Plus 4S Plan with Ortho pdf opens in new window

Advantage Plus 4S Plan pdf opens in new window

DHMO/Prepaid Dental by state

Some states may be limited in plan availability by county.

New 400 series Prepaid/DHMO plans are now available in select states.  

Arizona

EDS Prepaid 100N Plan – English pdf opens in new window
EDS Prepaid 100N Plan – Spanish  pdf opens in new window

EDS Prepaid 300N Plan – English pdf opens in new window
EDS Prepaid 300N Plan – Spanish pdf opens in new window

EDS Prepaid 700N Plan – English pdf opens in new window
EDS Prepaid 700N Plan – Spanish pdf opens in new window

California

LS100 Plan – English pdf opens in new window
LS100 Plan – Spanish pdf opens in new window

LS200 Plan – English pdf opens in new window
LS200 Plan – Spanish pdf opens in new window

LS300 Plan – English pdf opens in new window
LS300 Plan – Spanish pdf opens in new window

Delaware

Dominion National Select Plan 703 – English pdf opens in new window
Dominion National Select Plan 703 – Spanish pdf opens in new window

Dominion National Select Plan 705 – English pdf opens in new window
Dominion National Select Plan 705 – Spanish pdf opens in new window

Dominion National Select Plan 707 – English pdf opens in new window
Dominion National Select Plan 707 – Spanish pdf opens in new window

Dominion National Select Plan 703x – English pdf opens in new window
Dominion National Select Plan 703x – Spanish pdf opens in new window

Dominion National Select Plan 705x – English pdf opens in new window
Dominion National Select Plan 705x – Spanish pdf opens in new window

Dominion National Select Plan 705x Preventive Rewards Mid-Atlantic (MA) – English pdf opens in new window
Dominion National Select Plan 705x Preventive Rewards Mid-Atlantic (MA) – Spanish pdf opens in new window

Dominion National Select Plan 707x – English pdf opens in new window
Dominion National Select Plan 707x – Spanish pdf opens in new window

Dominion National Select Plan 703s – English pdf opens in new window
Dominion National Select Plan 703s – Spanish pdf opens in new window

Dominion National Select Plan 705s – English pdf opens in new window
Dominion National Select Plan 705s – Spanish pdf opens in new window

Dominion National Select Plan 707s – English pdf opens in new window
Dominion National Select Plan 707s – Spanish pdf opens in new window

Dominion National Select Plan 703xs – English pdf opens in new window
Dominion National Select Plan 703xs – Spanish pdf opens in new window

Dominion National Select Plan 705xs – English pdf opens in new window
Dominion National Select Plan 705xs – Spanish pdf opens in new window

Dominion National Select Plan 707xs – English pdf opens in new window
Dominion National Select Plan 707xs – Spanish pdf opens in new window

District of Columbia, Maryland, Pennsylvania, Virginia

Dominion National Select Plan 703 – English pdf opens in new window
Dominion National Select Plan 703 – Spanish pdf opens in new window

Dominion National Select Plan 705 – English pdf opens in new window
Dominion National Select Plan 705 – Spanish pdf opens in new window

Dominion National Select Plan 707 – English pdf opens in new window
Dominion National Select Plan 707 – Spanish pdf opens in new window

Dominion National Select Plan 703x – English pdf opens in new window
Dominion National Select Plan 703x – Spanish pdf opens in new window

Dominion National Select Plan 705x – English pdf opens in new window
Dominion National Select Plan 705x – Spanish pdf opens in new window

Dominion National Select Plan 705x Preventive Rewards Mid-Atlantic (MA) – English pdf opens in new window
Dominion National Select Plan 705x Preventive Rewards Mid-Atlantic (MA) – Spanish pdf opens in new window

Dominion National Select Plan 707x – English pdf opens in new window
Dominion National Select Plan 707x – Spanish pdf opens in new window

Dominion National Select Plan 703s – English pdf opens in new window
Dominion National Select Plan 703s – Spanish pdf opens in new window

Dominion National Select Plan 705s – English pdf opens in new window
Dominion National Select Plan 705s – Spanish pdf opens in new window

Dominion National Select Plan 707s – English pdf opens in new window
Dominion National Select Plan 707s – Spanish pdf opens in new window

Dominion National Select Plan 703xs – English pdf opens in new window
Dominion National Select Plan 703xs – Spanish pdf opens in new window

Dominion National Select Plan 705xs – English pdf opens in new window
Dominion National Select Plan 705xs – Spanish pdf opens in new window

Dominion National Select Plan 707xs – English pdf opens in new window
Dominion National Select Plan 707xs – Spanish pdf opens in new window

Florida

Prepaid HD405 Plan – English pdf opens in new window
Prepaid HD405 Plan – Spanish pdf opens in new window

Prepaid HD405 Plan with Ortho – English pdf opens in new window
Prepaid HD405 Plan with Ortho – Spanish pdf opens in new window

Prepaid HS405 Plan – English pdf opens in new window
Prepaid HS405 Plan – Spanish pdf opens in new window

Prepaid HS405 Plan with Implants – English pdf opens in new window
Prepaid HS405 Plan with Implants – Spanish pdf opens in new window

Prepaid HD410 Plan – English pdf opens in new window
Prepaid HD410 Plan – Spanish pdf opens in new window

Prepaid HD410 Plan with Ortho – English pdf opens in new window
Prepaid HD410 Plan with Ortho – Spanish pdf opens in new window

Prepaid HS410 Plan – English pdf opens in new window
Prepaid HS410 Plan – Spanish pdf opens in new window

Prepaid HS410 Plan with Implants – English pdf opens in new window
Prepaid HS410 Plan with Implants – Spanish pdf opens in new window

Prepaid HD415 Plan – English pdf opens in new window
Prepaid HD415 Plan – Spanish pdf opens in new window

Prepaid HD415 Plan with Ortho – English pdf opens in new window
Prepaid HD415 Plan with Ortho – Spanish pdf opens in new window

Prepaid HS415 Plan – English pdf opens in new window
Prepaid HS415 Plan – Spanish pdf opens in new window

Prepaid HS415 Plan with Implants – English pdf opens in new window
Prepaid HS415 Plan with Implants – Spanish pdf opens in new window

Prepaid 150 C Plan – English pdf opens in new window
Prepaid 150 C Plan – Spanish pdf opens in new window

Prepaid 150 C Plan with Ortho – English pdf opens in new window
Prepaid 150 C Plan with Ortho – Spanish pdf opens in new window

Prepaid 250 C Plan – English pdf opens in new window
Prepaid 250 C Plan – Spanish pdf opens in new window

Prepaid 250 C Plan with Ortho – English pdf opens in new window
Prepaid 250 C Plan with Ortho – Spanish pdf opens in new window

Prepaid 350 C Plan – English pdf opens in new window
Prepaid 350 C Plan – Spanish pdf opens in new window

Prepaid 350 C Plan with Ortho – English pdf opens in new window
Prepaid 350 C Plan with Ortho – Spanish pdf opens in new window

Prepaid 450 C Plan – English pdf opens in new window
Prepaid 450 C Plan – Spanish pdf opens in new window

Prepaid 450 C Plan with Ortho – English pdf opens in new window
Prepaid 450 C Plan with Ortho – Spanish pdf opens in new window

Prepaid 150 CS Plan – English pdf opens in new window
Prepaid 150 CS Plan – Spanish pdf opens in new window

Prepaid 250 CS Plan – English pdf opens in new window
Prepaid 250 CS Plan – Spanish pdf opens in new window

Prepaid 350 CS Plan – English pdf opens in new window
Prepaid 350 CS Plan – Spanish pdf opens in new window

Prepaid 450 CS Plan – English pdf opens in new window  
Prepaid 450 CS Plan – Spanish pdf opens in new window

Prepaid HD205 Plan – English pdf opens in new window
Prepaid HD205 Plan – Spanish pdf opens in new window

Prepaid HD205 Plan with Ortho – English pdf opens in new window
Prepaid HD205 Plan with Ortho – Spanish pdf opens in new window

Prepaid HS205 Plan – English pdf opens in new window
Prepaid HS205 Plan – Spanish pdf opens in new window

Prepaid HS205 Plan with Implants – English pdf opens in new window
Prepaid HS205 Plan with Implants – Spanish pdf opens in new window

Prepaid HD210 Plan – English pdf opens in new window
Prepaid HD210 Plan – Spanish pdf opens in new window

Prepaid HD210 Plan with Ortho – English pdf opens in new window
Prepaid HD210 Plan with Ortho – Spanish pdf opens in new window

Prepaid HS210 Plan – English pdf opens in new window
Prepaid HS210 Plan – Spanish pdf opens in new window

Prepaid HS210 Plan with Implants – English pdf opens in new window
Prepaid HS210 Plan with Implants – Spanish pdf opens in new window

Prepaid HD215 Plan – English pdf opens in new window
Prepaid HD215 Plan – Spanish pdf opens in new window

Prepaid HD215 Plan with Ortho – English pdf opens in new window
Prepaid HD215 Plan with Ortho – Spanish pdf opens in new window

Prepaid HS215 Plan – English pdf opens in new window
Prepaid HS215 Plan – Spanish pdf opens in new window

Prepaid HD190 Plan – English pdf opens in new window
Prepaid HD190 Plan – Spanish pdf opens in new window

Prepaid HD190 Plan with Ortho – English pdf opens in new window
Prepaid HD190 Plan with Ortho – Spanish pdf opens in new window

Prepaid HS190 Plan – English pdf opens in new window
Prepaid HS190 Plan – Spanish pdf opens in new window

Prepaid HS190 Plan with Implants – English pdf opens in new window
Prepaid HS190 Plan with Implants – Spanish pdf opens in new window

Prepaid HS195 Plan – English pdf opens in new window
Prepaid HS195 Plan – Spanish pdf opens in new window

Prepaid HS195 Plan with Implants – English pdf opens in new window
Prepaid HS195 Plan with Implants – Spanish pdf opens in new window

Prepaid Open Access – English pdf opens in new window
Prepaid Open Access – Spanish pdf opens in new window

Prepaid Open Access with Implants – English pdf opens in new window
Prepaid Open Access with Implants – Spanish  pdf opens in new window

Georgia

DHMO HD405 Plan – English pdf opens in new window
DHMO HD405 Plan – Spanish  pdf opens in new window

DHMO HD405 Plan with Ortho – English pdf opens in new window
DHMO HD405 Plan with Ortho – Spanish  pdf opens in new window

DHMO HS405 Plan – English pdf opens in new window
DHMO HS405 Plan – Spanish pdf opens in new window

DHMO HS405 Plan with Implants– English pdf opens in new window
DHMO HS405 Plan with Implants – Spanish  pdf opens in new window

DHMO HD410 Plan – English pdf opens in new window
DHMO HD410 Plan – Spanish  pdf opens in new window

DHMO HD410 Plan with Ortho – English pdf opens in new window
DHMO HD410 Plan with Ortho – Spanish pdf opens in new window

DHMO HS410 Plan – English pdf opens in new window
DHMO HS410 Plan – Spanish pdf opens in new window

DHMO HS410 Plan with Implants – English pdf opens in new window
DHMO HS410 Plan with Implants – Spanish pdf opens in new window

DHMO HD415 Plan – English pdf opens in new window
DHMO HD415 Plan – Spanish pdf opens in new window

DHMO HD415 Plan with Ortho – English pdf opens in new window
DHMO HD415 Plan with Ortho– Spanish pdf opens in new window

DHMO HS415 Plan – English pdf opens in new window
DHMO HS415 Plan – Spanish pdf opens in new window

DHMO HS415 Plan with Implants – English pdf opens in new window
DHMO HS415 Plan with Implants – Spanish pdf opens in new window

DHMO HD205 Plan – English pdf opens in new window
DHMO HD205 Plan – Spanish pdf opens in new window

DHMO HD205 Plan with Ortho – English pdf opens in new window
DHMO HD205 Plan with Ortho – Spanish pdf opens in new window

DHMO HS205 Plan – English pdf opens in new window
DHMO HS205 Plan – Spanish pdf opens in new window

DHMO HS205 Plan with Implants – English pdf opens in new window
DHMO HS205 Plan with Implants – Spanish pdf opens in new window

DHMO HD210 Plan – English pdf opens in new window
DHMO HD210 Plan – Spanish pdf opens in new window

DHMO HD210 Plan with Ortho – English pdf opens in new window
DHMO HD210 Plan with Ortho – Spanish pdf opens in new window

DHMO HS210 Plan – English pdf opens in new window
DHMO HS210 Plan – Spanish pdf opens in new window

DHMO HS210 Plan with Implants – English pdf opens in new window
DHMO HS210 Plan with Implants – Spanish pdf opens in new window

DHMO HD215 Plan – English pdf opens in new window
DHMO HD215 Plan – Spanish pdf opens in new window

DHMO HD215 Plan with Ortho – English pdf opens in new window
DHMO HD215 Plan with Ortho – Spanish pdf opens in new window

DHMO HS215 Plan – English pdf opens in new window
DHMO HS215 Plan – Spanish pdf opens in new window

DHMO HS2195 Plan – English pdf opens in new window
DHMO HS195 Plan – Spanish pdf opens in new window

DHMO HS2195 Plan with Implants – English pdf opens in new window
DHMO HS195 Plan with Implants – Spanish pdf opens in new window

Illinois, Indiana, Missouri, Tennessee

DHMO/Prepaid HD405 Plan – English pdf opens in new window
DHMO/Prepaid HD405 Plan – Spanish pdf opens in new window

DHMO/Prepaid HD405 Plan with Ortho – English pdf opens in new window
DHMO/Prepaid HD405 Plan with Ortho – Spanish pdf opens in new window

DHMO/Prepaid HS405 Plan – English pdf opens in new window
DHMO/Prepaid HS405 Plan – Spanish pdf opens in new window

DHMO/Prepaid HS405 Plan with Implants – English pdf opens in new window
DHMO/Prepaid HS405 Plan with Implants – Spanish pdf opens in new window

DHMO/Prepaid HD410 Plan – English pdf opens in new window
DHMO/Prepaid HD410 Plan – Spanish pdf opens in new window

DHMO/Prepaid HD410 Plan with Ortho – English pdf opens in new window
DHMO/Prepaid HD410 Plan with Ortho – Spanish pdf opens in new window

DHMO/Prepaid HS410 Plan – English pdf opens in new window
DHMO/Prepaid HS410 Plan – Spanish pdf opens in new window

DHMO/Prepaid HS410 Plan with Implants – English pdf opens in new window
DHMO/Prepaid HS410 Plan with Implants – Spanish pdf opens in new window

DHMO/Prepaid HD415 Plan – English pdf opens in new window
DHMO/Prepaid HD415 Plan – Spanish pdf opens in new window

DHMO/Prepaid HD415 Plan with Ortho – English pdf opens in new window
DHMO/Prepaid HD415 Plan with Ortho – Spanish pdf opens in new window

DHMO/Prepaid HS415 Plan – English pdf opens in new window
DHMO/Prepaid HS415 Plan – Spanish pdf opens in new window

DHMO/Prepaid HS415 Plan with Implants – English pdf opens in new window
DHMO/Prepaid HS415 Plan with Implants – Spanish pdf opens in new window

Prepaid 150 C Plan – English pdf opens in new window
Prepaid 150 C Plan – Spanish pdf opens in new window

Prepaid 150 C Plan with Ortho – English pdf opens in new window
Prepaid 150 C Plan with Ortho – Spanish pdf opens in new window

Prepaid 250 C Plan – English pdf opens in new window
Prepaid 250 C Plan – Spanish pdf opens in new window

Prepaid 250 C Plan with Ortho – English pdf opens in new window
Prepaid 250 C Plan with Ortho – Spanish pdf opens in new window

Prepaid 350 C Plan – English pdf opens in new window
Prepaid 350 C Plan – Spanish pdf opens in new window

Prepaid 350 C Plan with Ortho – English pdf opens in new window
Prepaid 350 C Plan with Ortho – Spanish pdf opens in new window

Prepaid 450 C Plan – English pdf opens in new window
Prepaid 450 C Plan – Spanish pdf opens in new window

Prepaid 450 C Plan with Ortho – English pdf opens in new window
Prepaid 450 C Plan with Ortho – Spanish pdf opens in new window

Prepaid 150 CS Plan – English pdf opens in new window
Prepaid 150 CS Plan – Spanish pdf opens in new window

Prepaid 250 CS Plan – English pdf opens in new window
Prepaid 250 CS Plan – Spanish pdf opens in new window

Prepaid 350 CS Plan – English pdf opens in new window
Prepaid 350 CS Plan – Spanish pdf opens in new window

Prepaid 450 CS Plan – English pdf opens in new window
Prepaid 450 CS Plan – Spanish pdf opens in new window

DHMO HD205 Plan – English pdf opens in new window
DHMO HD205 Plan – Spanish pdf opens in new window

DHMO HD205 Plan with Ortho – English pdf opens in new window
DHMO HD205 Plan with Ortho – Spanish pdf opens in new window

DHMO HS205 Plan – English pdf opens in new window
DHMO HS205 Plan – Spanish pdf opens in new window

DHMO HS205 Plan with Implants – English pdf opens in new window
DHMO HS205 Plan with Implants – Spanish pdf opens in new window

DHMO HD 210 Plan – English pdf opens in new window
DHMO HD 210 Plan – Spanish pdf opens in new window

DHMO HD 210 Plan with Ortho – English pdf opens in new window
DHMO HD 210 Plan with Ortho – Spanish pdf opens in new window

DHMO HS 210 Plan – English pdf opens in new window
DHMO HS 210 Plan – Spanish pdf opens in new window

DHMO HS 210 Plan with Implants – English pdf opens in new window
DHMO HS 210 Plan with Implants – Spanish pdf opens in new window

DHMO HD 215 Plan – English pdf opens in new window
DHMO HD 215 Plan – Spanish pdf opens in new window

DHMO HD 215 Plan with Ortho – English pdf opens in new window
DHMO HD 215 Plan with Ortho – Spanish pdf opens in new window

DHMO HS 215 Plan – English pdf opens in new window
DHMO HS 215 Plan – Spanish pdf opens in new window

Indiana, Mississippi, Missouri, Tennessee

DHMO 150 C Plan – English pdf opens in new window
DHMO 150 C Plan – Spanish pdf opens in new window

DHMO 150 C Plan with Ortho – English pdf opens in new window
DHMO 150 C Plan with Ortho – Spanish pdf opens in new window

DHMO 250 C Plan – English pdf opens in new window
DHMO 250 C Plan – Spanish pdf opens in new window

DHMO 250 C Plan with Ortho – English pdf opens in new window
DHMO 250 C Plan with Ortho – Spanish pdf opens in new window

DHMO 350 C Plan – English pdf opens in new window
DHMO 350 C Plan – Spanish pdf opens in new window

DHMO 350 C Plan with Ortho – English pdf opens in new window
DHMO 350 C Plan with Ortho – Spanish pdf opens in new window

DHMO 450 C Plan – English pdf opens in new window
DHMO 450 C Plan – Spanish pdf opens in new window

DHMO 450 C Plan with Ortho – English pdf opens in new window
DHMO 450 C Plan with Ortho – Spanish pdf opens in new window

DHMO 150 CS Plan – English pdf opens in new window
DHMO 150 CS Plan – Spanish pdf opens in new window

DHMO 250 CS Plan – English pdf opens in new window
DHMO 250 CS Plan – Spanish pdf opens in new window

DHMO 350 CS Plan – English pdf opens in new window
DHMO 350 CS Plan – Spanish pdf opens in new window

DHMO 450 CS Plan – English pdf opens in new window
DHMO 450 CS Plan – Spanish pdf opens in new window

Kansas, Kentucky

DHMO/Prepaid HD405 Plan – English pdf opens in new window
DHMO/Prepaid HD405 Plan – Spanish pdf opens in new window

DHMO/Prepaid HD405 Plan with Ortho – English pdf opens in new window
DHMO/Prepaid HD405 Plan with Ortho  – Spanish pdf opens in new window

DHMO/Prepaid HS405 Plan – English pdf opens in new window
DHMO/Prepaid HS405 Plan – Spanish pdf opens in new window

DHMO/Prepaid HS405 Plan with Implants – English pdf opens in new window
DHMO/Prepaid HS405 Plan with Implants – Spanish pdf opens in new window

DHMO/Prepaid HD410 Plan – English pdf opens in new window
DHMO/Prepaid HD410 Plan – Spanish pdf opens in new window

DHMO/Prepaid HD410 Plan with Ortho – English pdf opens in new window
DHMO/Prepaid HD410 Plan with Ortho – Spanish pdf opens in new window

DHMO/Prepaid HS410 Plan – English pdf opens in new window
DHMO/Prepaid HS410 Plan – Spanish pdf opens in new window

DHMO/Prepaid HS410 Plan with Implants – English pdf opens in new window
DHMO/Prepaid HS410 Plan with Implants – Spanish pdf opens in new window

DHMO/Prepaid HD415 Plan – English pdf opens in new window
DHMO/Prepaid HD415 Plan – Spanish pdf opens in new window

DHMO/Prepaid HD415 Plan with Ortho – English pdf opens in new window
DHMO/Prepaid HD415 Plan with Ortho – Spanish pdf opens in new window

DHMO/Prepaid HS415 Plan – English pdf opens in new window
DHMO/Prepaid HS415 Plan – Spanish pdf opens in new window

DHMO/Prepaid HS415 Plan with Implants – English pdf opens in new window
DHMO/Prepaid HS415 Plan with Implants – Spanish pdf opens in new window

DHMO 150 C Plan – English pdf opens in new window
DHMO 150 C Plan – Spanish pdf opens in new window

DHMO 150 C Plan with Ortho – English pdf opens in new window
DHMO 150 C Plan with Ortho – Spanish pdf opens in new window

DHMO 250 C Plan – English pdf opens in new window
DHMO 250 C Plan – Spanish pdf opens in new window

DHMO 250 C Plan with Ortho – English pdf opens in new window
DHMO 250 C Plan with Ortho – Spanish pdf opens in new window

DHMO 350 C Plan – English pdf opens in new window
DHMO 350 C Plan – Spanish pdf opens in new window

DHMO 350 C Plan with Ortho – English pdf opens in new window
DHMO 350 C Plan with Ortho – Spanish pdf opens in new window

DHMO 450 C Plan – English pdf opens in new window
DHMO 450 C Plan – Spanish pdf opens in new window

DHMO 450 C Plan with Ortho – English pdf opens in new window
DHMO 450 C Plan with Ortho – Spanish pdf opens in new window

DHMO 150 CS Plan – English pdf opens in new window
DHMO 150 CS Plan – Spanish pdf opens in new window

DHMO 250 CS Plan – English pdf opens in new window
DHMO 250 CS Plan – Spanish pdf opens in new window

DHMO 350 CS Plan – English pdf opens in new window
DHMO 350 CS Plan – Spanish pdf opens in new window

DHMO 450 CS Plan – English pdf opens in new window
DHMO 450 CS Plan – Spanish pdf opens in new window

DHMO/Prepaid HD205 Plan – English pdf opens in new window
DHMO/Prepaid HD205 Plan – Spanish pdf opens in new window

DHMO/Prepaid HD205 Plan with Ortho – English pdf opens in new window
DHMO/Prepaid HD205 Plan with Ortho – Spanish pdf opens in new window

DHMO/Prepaid HS205 Plan – English pdf opens in new window
DHMO/Prepaid HS205 Plan – Spanish pdf opens in new window

DHMO/Prepaid HS205 Plan with Implants – English pdf opens in new window
DHMO/Prepaid HS205 Plan with Implants – Spanish pdf opens in new window

DHMO/Prepaid HD210 Plan – English pdf opens in new window
DHMO/Prepaid HD210 Plan – Spanish pdf opens in new window

DHMO/Prepaid HD210 Plan with Ortho – English pdf opens in new window
DHMO/Prepaid HD210 Plan with Ortho – Spanish pdf opens in new window

DHMO/Prepaid HS210 Plan – English pdf opens in new window
DHMO/Prepaid HS210 Plan – Spanish pdf opens in new window

DHMO/Prepaid HS210 Plan with Implants – English pdf opens in new window
DHMO/Prepaid HS210 Plan with Implants – Spanish pdf opens in new window

DHMO/Prepaid HD215 Plan – English pdf opens in new window
DHMO/Prepaid HD215 Plan – Spanish pdf opens in new window

DHMO/Prepaid HD215 Plan with Ortho – English pdf opens in new window
DHMO/Prepaid HD215 Plan with Ortho – Spanish pdf opens in new window

DHMO/Prepaid HS215 Plan – English pdf opens in new window
DHMO/Prepaid HS215 Plan – Spanish pdf opens in new window

New Jersey

Dominion National Select Plan 703x – English pdf opens in new window
Dominion National Select Plan 703x – Spanish pdf opens in new window

Dominion National Select Plan 705x – English pdf opens in new window
Dominion National Select Plan 705x – Spanish pdf opens in new window

Dominion National Select Plan 707x – English pdf opens in new window
Dominion National Select Plan 707x – Spanish pdf opens in new window

Dominion National Select Plan 705x Preventive Rewards – English pdf opens in new window
Dominion National Select Plan 705x Preventive Rewards – Spanish pdf opens in new window

Texas

DHMO HD405 Plan– English pdf opens in new window
DHMO HD405 Plan – Spanish pdf opens in new window

DHMO HD405 Plan with Ortho – English pdf opens in new window
DHMO HD405 Plan with Ortho – Spanish pdf opens in new window

DHMO HS405 Plan – English pdf opens in new window
DHMO HS405 Plan – Spanish pdf opens in new window

DHMO HS405 Plan with Implants – English pdf opens in new window
DHMO HS405 Plan with Implants – Spanish pdf opens in new window

DHMO HD410 Plan – English pdf opens in new window
DHMO HD410 Plan – Spanish pdf opens in new window

DHMO HD410 Plan with Ortho – English pdf opens in new window
DHMO HD410 Plan with Ortho – Spanish pdf opens in new window

DHMO HS410 Plan – English pdf opens in new window
DHMO HS410 Plan – Spanish pdf opens in new window

DHMO HS410 Plan with Implants – English pdf opens in new window
DHMO HS410 Plan with Implants – Spanish pdf opens in new window

DHMO HD415 Plan – English pdf opens in new window
DHMO HD415 Plan – Spanish pdf opens in new window

DHMO HD415 Plan with Ortho – English pdf opens in new window
DHMO HD415 Plan with Ortho – Spanish pdf opens in new window

DHMO HS415 Plan – English pdf opens in new window
DHMO HS415 Plan – Spanish pdf opens in new window

DHMO HS415 Plan with Implants – English pdf opens in new window
DHMO HS415 Plan with Implants – Spanish pdf opens in new window

DHMO 150 C Plan – English pdf opens in new window
DHMO 150 C Plan – Spanish pdf opens in new window

DHMO 150 C Plan with Ortho – English pdf opens in new window
DHMO 150 C Plan with Ortho – Spanish pdf opens in new window

DHMO 250 C Plan – English pdf opens in new window
DHMO 250 C Plan – Spanish pdf opens in new window

DHMO 250 C Plan with Ortho – English pdf opens in new window
DHMO 250 C Plan with Ortho – Spanish pdf opens in new window

DHMO 350 C Plan – English pdf opens in new window
DHMO 350 C Plan – Spanish pdf opens in new window

DHMO 350 C Plan with Ortho – English pdf opens in new window
DHMO 350 C  Plan with Ortho – Spanish pdf opens in new window

DHMO 450 C Plan – English pdf opens in new window
DHMO 450 C Plan – Spanish pdf opens in new window

DHMO 450 C Plan with Ortho – English pdf opens in new window
DHMO 450 C Plan with Ortho – Spanish pdf opens in new window

DHMO 150 CS Plan – English pdf opens in new window
DHMO 150 CS Plan – Spanish pdf opens in new window

DHMO 250 CS Plan – English pdf opens in new window
DHMO 250 CS Plan – Spanish pdf opens in new window

DHMO 350 CS Plan – English pdf opens in new window
DHMO 350 CS Plan – Spanish pdf opens in new window

DHMO 450 CS Plan – English pdf opens in new window
DHMO 450 CS Plan – Spanish pdf opens in new window

DHMO 600 CS Plan – English pdf opens in new window
DHMO 600 CS Plan – Spanish pdf opens in new window

DHMO HD205 Plan – English pdf opens in new window
DHMO HD205 Plan – Spanish pdf opens in new window

DHMO HD205 with Ortho – English pdf opens in new window
DHMO HD205 with Ortho – Spanish pdf opens in new window

DHMO HS205 Plan – English pdf opens in new window
DHMO HS205 Plan – Spanish pdf opens in new window

DHMO HS205 Plan with Implants – English pdf opens in new window
DHMO HS205 Plan with Implants – Spanish pdf opens in new window

DHMO HD210 Plan – English pdf opens in new window
DHMO HD210 Plan – Spanish pdf opens in new window

DHMO HD210 Plan with Ortho – English pdf opens in new window
DHMO HD210 Plan with Ortho – Spanish pdf opens in new window

DHMO HS210 Plan – English pdf opens in new window
DHMO HS210 Plan – Spanish pdf opens in new window

DHMO HS210 Plan with Implants – English pdf opens in new window
DHMO HS210 Plan with Implants – Spanish pdf opens in new window

DHMO HD215 Plan – English pdf opens in new window
DHMO HD215 Plan – Spanish pdf opens in new window

DHMO HD215 Plan with Ortho – English pdf opens in new window
DHMO HD215 Plan with Ortho – Spanish pdf opens in new window

DHMO HS215 Plan – English pdf opens in new window
DHMO HS215 Plan – Spanish pdf opens in new window

Prepaid HD190 Plan – English pdf opens in new window
Prepaid HD190 Plan – Spanish pdf opens in new window

DHMO HD190 Plan with Ortho – English pdf opens in new window
DHMO HD190 Plan with Ortho – Spanish pdf opens in new window

DHMO HS190 Plan – English pdf opens in new window
DHMO HS190 Plan – Spanish pdf opens in new window

DHMO HS190 Plan with Implants – English pdf opens in new window
DHMO HS190 Plan with Implants – Spanish pdf opens in new window

Vision care by state

Some states may be limited in plan availability by county.

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Idaho, Illinois, Indiana, Iowa, Louisiana, Michigan, Minnesota, Mississippi, Nebraska, Nevada, New York, North Carolina, North Dakota, New Jersey, New Mexico, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, West Virginia, Wisconsin

Vision Care Plan – English pdf opens in new window
Vision Care Plan – English (editable) pdf opens in new window
Vision Care Plan – Spanish pdf opens in new window
Vision Care Plan – Spanish (editable) pdf opens in new window

Connecticut, Maine, Massachusetts, New Hampshire, Vermont

Vision Care Plan – English pdf opens in new window
Vision Care Plan – English (editable) pdf opens in new window
Vision Care Plan – Spanish pdf opens in new window
Vision Care Plan – Spanish (editable) pdf opens in new window

Florida

Vision Care Plan – English pdf opens in new window
Vision Care Plan – English (editable) pdf opens in new window
Vision Care Plan – Spanish pdf opens in new window
Vision Care Plan – Spanish (editable) pdf opens in new window

Georgia

Vision Care Plan – English pdf opens in new window
Vision Care Plan – English (editable) pdf opens in new window
Vision Care Plan – Spanish pdf opens in new window
Vision Care Plan – Spanish (editable) pdf opens in new window

Kansas, Missouri

Vision Care Plan – English pdf opens in new window
Vision Care Plan – English (editable) pdf opens in new window
Vision Care Plan – Spanish pdf opens in new window
Vision Care Plan – Spanish (editable) pdf opens in new window

Kentucky

Vision Care Plan – English pdf opens in new window
Vision Care Plan – English (editable) pdf opens in new window
Vision Care Plan – Spanish pdf opens in new window
Vision Care Plan – Spanish (editable) pdf opens in new window

Maryland, Virginia, Washington D.C.

Vision Care Plan – English pdf opens in new window
Vision Care Plan – English (editable) pdf opens in new window
Vision Care Plan – Spanish pdf opens in new window
Vision Care Plan – Spanish (editable) pdf opens in new window

Texas

Vision Care Plan – English pdf opens in new window
Vision Care Plan – English (editable) pdf opens in new window
Vision Care Plan – Spanish pdf opens in new window
Vision Care Plan – Spanish (editable) pdf opens in new window

Exam Plus by state

Some states may be limited in plan availability by county.

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, West Virginia, Wisconsin

Exam Plus plan – English pdf opens in new window
Exam Plus plan – Spanish pdf opens in new window

Kansas, Missouri

Exam Plus plan – English pdf opens in new window
Exam Plus plan – Spanish pdf opens in new window