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Alaska
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Atlantic City - Casinos
Atlantic City - Non-Casinos
Citizens Bank Park P/T Plan
Pittsburgh
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Boston Area
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Chicago Hotels
Chicago Sporting Events
Chicago Restaurants
Detroit
Midwest Casino
California Region
Long Beach/Orange County
SPD:
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SBCs
SBC 69
Kaiser HMO with LA Dental Center and no vision
Kaiser HMO with LA Dental Center and UnitedHealthcare vision benefits
SBC 462
Kaiser HMO only
Kaiser HMO with Liberty dental benefits and/or UnitedHealthcare vision benefits
SMMs
Los Angeles
Monterey Culinary Health Plan
New York Region
New York Plan
Greater New York Regional Hotel Plan
National Plans
Delaware North Companies - Base Plan
Delaware North Companies - Alternate I and II
Delaware North Companies - Alternate III
Food Service Plan - BCBS (Plans A, B, and C)
Evidence of coverage (EoC) files for Plans A, B and CDelta Dental DHMO
- Get your dental HMO EOC from Delta at www.deltadentalins.com/deltacare or by calling (800) 422-4234.
Please disregard the Eligibility and Termination sections in the EOC—the Fund determines who is eligible.
Plan A SPD SBCs
- Plan A SBC 73
- Medical benefits with 24-month Basic Vision plan and no dental
- Medical benefits with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
- Plan A SBC 75
- Medical benefits only
- Medical benefits with Davis Vision benefits and/or Delta Dental DPPO or DHMO dental benefits
Plan A SMMs
Plan B SPD SBCs
- Plan B SBC 80
- Medical benefits with 24-month Basic Vision plan and no dental
- Medical benefits with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
- Plan B SBC 137
- Medical benefits only
- Medical benefits with Davis Vision benefits and/or Delta Dental DPPO or DHMO dental benefits
Plan B SMMs
Plan C SPD SBCs
- Plan C SBC 86
- Medical benefits with 24-month Basic Vision plan and no dental
- Medical benefits with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
- Plan C SBC 140
- Medical benefits only
- Medical benefits with Davis Vision benefits and/or Delta Dental DPPO or DHMO dental benefits
Plan C SMMs
Food Service Plan - Kaiser (Plans D and E)
Plan D SPD Evidence of Coverage (EoC) filesMedical
Delta Dental DHMO
- Get your dental HMO EOC from Delta at www.deltadentalins.com/deltacare or by calling (800) 422-4234.
Please disregard the Eligibility and Termination sections in the EOC—the Fund determines who is eligible.
SBCs
- Plan D SBC 100
- Kaiser Select High HMO with 24-month Basic Vision plan and no dental
- Kaiser Select High HMO with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
- Plan D SBC 102
- Kaiser Select High HMO only
- Kaiser Select High HMO with Davis Vision benefits and/or Delta Dental DPPO or DHMO dental benefits
- Plan D SBC 110
- Kaiser Signature or Select Low HMO with 24-month Basic Vision plan and no dental
- Kaiser Signature or Select Low HMO with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
- Plan D SBC 111
- Kaiser Signature or Select Low HMO only
- Kaiser Signature or Select Low HMO with Davis Vision benefits and/or Delta Dental DPPO or DHMO dental benefits
Plan D SMMs
Plan E SPD Evidence of Coverage (EoC) filesMedical
Delta Dental DHMO
- Get your dental HMO EOC from Delta at www.deltadentalins.com/deltacare or by calling (800) 422-4234.
Please disregard the Eligibility and Termination sections in the EOC—the Fund determines who is eligible.
SBCs
- Plan E SBC 125
- Kaiser++ HMO with 24-month Basic Vision plan and no dental
- Kaiser++ HMO with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
- Plan E SBC 454
- Kaiser++ HMO only
- Kaiser++ HMO with Davis Vision benefits and/or Delta Dental DPPO or DHMO dental benefits
Plan E SMMs
Food Service Plan II (BCBS PPO)
SPDEvidence of coverage (EoC) filesDental DHMO
- Get your dental HMO EOC from Delta at www.deltadentalins.com/deltacare or by calling (800) 422-4234.
Please disregard the Eligibility and Termination sections in the EOC—the Fund determines who is eligible.
SMMs
Food Service Plan II (California Kaiser)
SPDWrap SPDsMedical
Delta Dental DHMO
- Get your dental HMO EOC from Delta at www.deltadentalins.com/deltacare or by calling (800) 422-4234.
Please disregard the Eligibility and Termination sections in the EOC—the Fund determines who is eligible.
SMMs
Food Service Plan II (Colorado/Georgia Kaiser)
SPD Evidence of Coverage Kaiser HMO
Delta Dental DHMO
- Get your dental HMO EOC from Delta at www.deltadentalins.com/deltacare or by calling (800) 422-4234.
Please disregard the Eligibility and Termination sections in the EOC—the Fund determines who is eligible.
SMMs
Food Service Plan II (DC/Baltimore Kaiser)
SPD Evidence of coverage (EoC) filesMedical
Delta Dental DHMO
- Get your dental HMO EOC from Delta at www.deltadentalins.com/deltacare or by calling (800) 422-4234.
Please disregard the Eligibility and Termination sections in the EOC—the Fund determines who is eligible.
SMMs
Food Service Plan II SBCs
Platinum+
- SBC 468:
- Platinum+ medical benefits only
- Platinum+ medical benefits with VSP vision benefits and/or Delta Dental DPPO or DHMO dental benefits
- SBC 469:
- Platinum+ medical benefits with 24-month Basic Vision plan and no dental
- Platinum+ medical benefits with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
Platinum
- SBC 470:
- Platinum medical benefits only
- SBC 471:
- Platinum medical benefits with 24-month Basic Vision plan and no dental
- Platinum medical benefits with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
Gold+
- SBC 472:
- Gold+ medical benefits only
- Gold+ medical benefits with VSP vision benefits and/or Delta Dental DPPO or DHMO dental benefits
- SBC 473:
- Gold+ medical benefits with 24-month Basic Vision plan and no dental
- Gold+ medical benefits with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
- SBC 474:
- Gold+ medical benefits with LA Dental Center and no vision
- Gold+ medical benefits with LA Dental Center and VSP vision benefits
- SBC 475:
- Gold+ medical benefits with 24-month Basic Vision plan and LA Dental Center
Silver+
- SBC 476:
- Silver+ medical benefits only
- Silver+ medical benefits with VSP vision benefits and/or Delta Dental DPPO or DHMO dental benefits
- SBC 477:
- Silver+ medical benefits with 24-month Basic Vision plan and no dental
- Silver+ medical benefits with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
- SBC 478:
- Silver+ medical benefits with LA Dental Center and no vision
- Silver+ medical benefits with LA Dental Center and VSP vision benefits
- SBC 479:
- Silver+ medical benefits with 24-month Basic Vision plan and LA Dental Center
Kaiser++
- SBC 484:
- Kaiser++ HMO only
- Kaiser++ HMO with VSP vision benefits and/or Delta Dental DPPO or DHMO dental benefits
- SBC 485:
- Kaiser++ HMO with 24-month Basic Vision plan and no dental
- Kaiser++ HMO with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
- SBC 486:
- Kaiser++ HMO with LA Dental Center and no vision
- Kaiser++ HMO with LA Dental Center and VSP vision benefits
- SBC 487:
- Kaiser++ HMO with LA Dental Center and VSP vision benefits
Kaiser Signature & Select Low
- SBC 488:
- Kaiser Signature or Select Low HMO only
- Kaiser Signature or Select Low HMO with VSP or Davis Vision benefits and/or Delta Dental DPPO or DHMO dental benefits
- SBC 489:
- Kaiser Signature or Select Low HMO with 24-month Basic Vision plan and no dental
- Kaiser Signature or Select Low HMO with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
Kaiser Select High
- SBC 492:
- Kaiser Select High HMO only
- Kaiser Select High HMO with VSP or Davis Vision benefits and/or Delta Dental DPPO or DHMO dental benefits
- SBC 493:
- Kaiser Select High HMO with 24-month Basic Vision plan and no dental
- Kaiser Select High HMO with 24-month Basic Vision plan and Delta Dental DPPO or DHMO dental benefits
Kaiser Colorado
Kaiser Georgia
Hospitality Plan
SPD
Evidence of coverage (EoC) files
Dental DHMO
- Get your dental HMO EOC from Delta at deltadentalins.com/deltacare or by calling (800) 422-4234.
Please disregard the Eligibility and Termination sections in the EOC—the Fund determines who is eligible.
SBC:
Gold+ -
Silver+ SMMs
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