Guide Preferred Provider Plan Dental Service Areas

By County

Barnstable County Preferred Provider Plan Dental Service

DENTAL Insured Preferred Provider Plans Product Name Form Number
Aetna Life Insurance Company Aetna Leap Dental PPO AL IVL CB-HDentalPol 05
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
American General Life Ins. Co.  1 Group Dental PPO Plan G-DEN-42000 MA
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc Altus Dental For Small Group Business AD200-GPRX (MA)
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
The Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA (07/17)
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Dental Service of Massachusetts, Inc. Delta Dental Preferred DDP-PPA1
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dental Service of Massachusetts, Inc. DeltaCare USA SP151-FDS
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. DeltaCare DSM.MA.DeltaCare.Ind.Sub.Cert.01.15 & Grp.Sub
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Renaissance Life and Health Ins. Co. of America Renaissance Massachusetts Group Dental Certificate D-2102A-2014-MA, D-202A & D-201A-2014-MA
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
UniCARE Life and Health Insurance Company Wellpoint Dental PPO GCR 130, 3119-31127
Union Security Insurance Company Dental Group Certificate GC-90 et al
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA
 

1 Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 The Lincoln National Life Insurance Company notified the Division on July 7, 2011 that effective October 1, 2011 the originally approved dental network [Connection Dental Network] will be replaced by the Dental Benefit Provider Network.
3 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

*Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Berkshire County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
Dearborn National Life Insurance Company Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/Carrington Maximum Care Network INVD-100A
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
Union Security Insurance Company Dental Group Certificate GC-90 et al
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316



1 Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

 

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Bristol County Preferred Provider Plan Dental Service

Dental Insured Provider Plans Product Name Form Number
Aetna Life Insurance Company Aetna Leap Dental PPO AL IVL CB-HDentalPol 05
Aetna Life Insurance Company Advantage Plus MA-DMO
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
CIGNA Health and Life Insurance Company CIGNA Dental PPO HP-POL63 et. Al
CIGNA Life and Health Insurance Company CIGNA Individual Dental PPO HC-NOT11 et. al./HC-CER33
Dearborn National Life Insurance Company 2 Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
Humana Insurance Company Dental PPO MA-70146-HC 1/14
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Renaissance Life and Health Ins. Co. of America Renaissance Massachusetts Group Dental Certificate D-2102A-2014-MA, D-202A & D-201A-2014-MA
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Starmount Life Insurance Company Group Dental w/DenteMax DN-2015GRPCT-MA
Sun Life Assurance Company of Canada
 
Dental PPO [w Aetna Dental Access®]
 
GC-A-1 et al.
 
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
UniCARE Life and Health Insurance Company Wellpoint Dental PPO CGR 130
Union Security Insurance Company 3 Dental Group Certificate GC-90 et al.
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA
 


1 Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
4 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Dukes County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc Altus Dental Preferred AD 1
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co. of Delaware 1 Group Dental PPO Plan G-DEN-42000 MA
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
The Lincoln National Life Insurance Company Group Dental Insurance GL11/GL12 Series
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316

1Effective December 8, 2009, AIG Life Insurance Company changed its name to American General Life Insurance Company of Delaware.
2 Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
3Effective March 24, 2006, company changed its name from GE Group Life Assurance Company to Genworth Life and Health Insurance Company.

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Essex County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Aetna Leap Dental PPO AL IVL CB-HDentalPol 05
Aetna Life Insurance Company Advantage Plus MA-DMO
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
CIGNA Health and Life Insurance Company CIGNA Dental PPO HP-POL63 et. Al
CIGNA Health and Life Insurance Company CIGNA Individual Dental PPO HC-NOT11 et. al./HC-CER33
Dearborn National Life Insurance Company 2 Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Dental Preferred DDP-PPA1
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dental Service of Massachusetts, Inc. DeltaCare USA SP151-FDS
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE AARP Dental Insurance Plan CC-DNNE-MA(DELTAUSA1-2005)D
DSM Massachusetts Insurance Company, Inc. DeltaCare DSM.MA.DeltaCare.Ind.Sub.Cert.01.15 & Grp.Sub
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
Humana Insurance Company Dental PPO MA-70146-HC 1/14
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ DenteMax Network INVD-100A
 
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Renaissance Massachusetts Group Dental Certificate D-2102A-2014-MA, D-202A & D-201A-2014-MA
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Starmount Life Insurance Company Group Dental w/DenteMax  DN-2015GRPCT-MA
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
UniCARE Life and Health Insurance Company Wellpoint Dental PPO CGR 130
Union Security Insurance Company 3 Dental Group Certificate GC-90 et al.
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA
 

Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
4 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Franklin County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc Delta Dental PPO Individual National DDP-PPA6
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
Fort Dearborn Life Insurance Company Group Dental Insurance 7P-100-1004
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]

1Effective December 8, 2009, AIG Life Insurance Company changed its name to American General Life Insurance Company of Delaware.
2 The Lincoln National Life Insurance Company notified the Division on July 7, 2011 that effective October 1, 2011 the originally approved dental network [Connection Dental Network] will be replaced by the Dental Benefit Provider Network.
3Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
4 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.
Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Hampden County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Advantage Plus MA-DMO
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
CIGNA Health and Life Insurance Company CIGNA Dental PPO HP-POL63 et. Al
CIGNA Health and Life Insurance Company CIGNA Individual Dental PPO HC-NOT11 et. al./HC-CER33
Dearborn National Life Insurance Company 2 Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Dental Preferred DDP-PPA1
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dental Service of Massachusetts, Inc. DeltaCare USA SP151-FDS
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred
IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Renaissance Life and Health Ins. Co. of America Renaissance Massachusetts Group Dental Certificate D-2102A-2014-MA, D-202A & D-201A-2014-MA
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
Union Security Insurance Company Dental Group Certificate GC-90 et al.
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA

1Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Hampshire County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
Dearborn National Life Insurance Company 2 Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred
IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
Union Security Insurance Company Dental Group Certificate GC-90 et al
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA

Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Middlesex County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Aetna Leap Dental PPO AL IVL CB-HDentalPol 05
Aetna Life Insurance Company Advantage Plus MA-DMO
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
CIGNA Health and Life Insurance Company CIGNA Dental PPO HP-POL63 et. Al
CIGNA Health and Life Insurance Company CIGNA Individual Dental PPO HC-NOT11 et. al./HC-CER33
Dearborn National Life Insurance Company 2 Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Dental Preferred DDP-PPA1
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dental Service of Massachusetts, Inc. DeltaCare USA SP151-FDS
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE AARP Dental Insurance Plan CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. DeltaCare DSM.MA.DeltaCare.Ind.Sub.Cert.01.15 & Grp.Sub
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
Humana Insurance Company Dental PPO MA-70146-HC 1/14
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Renaissance Life and Health Ins. Co. of America Renaissance Massachusetts Group Dental Certificate D-2102A-2014-MA, D-202A & D-201A-2014-MA
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Starmount Life Insurance Company Group Dental w/DenteMax DN-2015GRPCT-MA
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Sun Life and Health Insurance Company 4 Dental PPO [DenteMax Network]

 
GC-A-1 et al.
 
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
UniCARE Life and Health Insurance Company Wellpoint Dental PPO CGR 130
Union Security Insurance Company 5 Dental Group Certificate GC-90 et al.
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA
 

1Effective December 8, 2009, AIG Life Insurance Company changed its name to American General Life Insurance Company of Delaware.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3 The Lincoln National Life Insurance Company notified the Division on July 7, 2011 that effective October 1, 2011 the originally approved dental network [Connection Dental Network] will be replaced by the Dental Benefit Provider Network.
4Effective December 1, 2007, Genworth Life and Health Insurance Company changed its name to Sun Life and Health Insurance Company.
5Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
6 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

*  Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Nantucket County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co. of Delaware 1 Group Dental PPO Plan G-DEN-42000 MA
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta

1Effective December 8, 2009, AIG Life Insurance Company changed its name to American General Life Insurance Company of Delaware.
2Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
3Effective March 24, 2006, company changed its name from GE Group Life Assurance Company to Genworth Life and Health Insurance Company.

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Norfolk County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Aetna Leap Dental PPO AL IVL CB-HDentalPol 05
Aetna Life Insurance Company Advantage Plus MA-DMO
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
CIGNA Health and Life Insurance Company CIGNA Dental PPO HP-POL63 et. Al
CIGNA Health and Life Insurance Company CIGNA Individual Dental PPO HC-NOT11 et. al./HC-CER33
Dearborn National Life Insurance Company 2 Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. DeltaCare DSM.MA.DeltaCare.Ind.Sub.Cert.01.15 & Grp.Sub
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
Humana Insurance Company Dental PPO MA-70146-HC 1/14
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 100 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Renaissance Life and Health Ins. Co. of America Renaissance Massachusetts Group Dental Certificate D-2102A-2014-MA, D-202A & D-201A-2014-MA
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Starmount Life Insurance Company Group Dental w/DenteMax DN-2015GRPCT-MA
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
UniCARE Life and Health Insurance Company Wellpoint Dental PPO CGR 130
Union Security Insurance Company 3 Dental Group Certificate GC-90 et al.
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA

1Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
4 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Plymouth County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Aetna Leap Dental PPO AL IVL CB-HDentalPol 05
Aetna Life Insurance Company Advantage Plus MA-DMO
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
CIGNA Health and Life Insurance Company CIGNA Dental PPO HP-POL63 et. Al
CIGNA Life and Health Insurance Company CIGNA Individual Dental PPO HC-NOT11 et. al./HC-CER33
Dearborn National Life Insurance Company 2 Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Dental Preferred DDP-PPA1
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc Delta Dental PPO Individual National DDP-PPA6
Dental Service of Massachusetts, Inc DeltaCare USA SP151-FDS
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. DeltaCare DSM.MA.DeltaCare.Ind.Sub.Cert.01.15 & Grp.Sub
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
Humana Insurance Company Dental PPO MA-70146-HC 1/14
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Renaissance Life and Health Ins. Co. of America Renaissance Massachusetts Group Dental Certificate D-2102A-2014-MA, D-202A & D-201A-2014-MA
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Starmount Life Insurance Company Group Dental w/DenteMax DN-2015GRPCT-MA
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
UniCARE Life and Health Insurance Company Wellpoint Dental PPO CGR 130
Union Security Insurance Company 3 Dental Group Certificate GC-90 et al.
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA
 

1Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
4 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Suffolk County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Advantage Plus MA-DMO
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
CIGNA Health and Life Insurance Company CIGNA Dental PPO HP-POL63 et. Al
CIGNA Health and Life Insurance Company CIGNA Individual Dental PPO HC-NOT11 et. al./HC-CER33
Dearborn National Life Insurance Company 2 Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Dental Preferred DDP-PPA1
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dental Service of Massachusetts, Inc. DeltaCare USA SP151-FDS
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. DeltaCare DSM.MA.DeltaCare.Ind.Sub.Cert.01.15 & Grp.Sub
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company
 
Dental Plan Certificate of Insurance
 
MA-70146-HD 1/09 et al.
 
Humana Insurance Company Dental PPO MA-70146-HC 1/14
The Lincoln National Life Insurance Company
 
Group Dental Insurance
 
GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 100 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
Renaissance Life and Health Ins. Co. of America Renaissance Massachusetts Group Dental Certificate D-2102A-2014-MA, D-202A & D-201A-2014-MA
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Starmount Life Insurance Company Group Dental w/DenteMax  DN-2015GRPCT-MA
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
UniCARE Life and Health Insurance Company Wellpoint Dental PPO CGR 130
Union Security Insurance Company 3 Dental Group Certificate GC-90 et al.
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA

1Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
4Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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Worcester County Preferred Provider Plan Dental Service

DENTAL
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Aetna Leap Dental PPO AL IVL CB-HDentalPol 05
Aetna Life Insurance Company Advantage Plus MA-DMO
Aetna Life Insurance Company Dental PPO MA-Dental PPO
Aetna Life Insurance Company Advantage Plus MA-DMO Copay Plans
Altus Dental Insurance Company, Inc. Altus Dental Preferred AD 1 v.4
Altus Dental Insurance Company, Inc. Altus Dental Preferred - AAA Members AD 3C
Altus Dental Insurance Company, Inc. Altus Dental Value Option Plan 1 AD 5
 
Altus Dental Insurance Company, Inc. Altus Dental For 1 AD100-IND (MA)
Altus Dental Insurance Company, Inc. Altus Dental Individual AD200-INDX (MA)
Altus Dental Insurance Company, Inc. Altus Dental For Small Group Business AD200-GPRX (MA)
American General Life Ins. Co.1 Group Dental PPO Plan G-DEN-42000 MA
Ameritas Life Insurance Corp. Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 1 DENT PPO1
Blue Cross and Blue Shield of Massachusetts, Inc. Dental Blue PPO Program 2 DENT PPO2
Chesapeake Life Insurance Company PPO Dental Plan CH-26121-IP (01/12) MA
CIGNA Health and Life Insurance Company CIGNA Dental PPO HP-POL63 et. Al
CIGNA Health and Life Insurance Company CIGNA Individual Dental PPO HC-NOT11 et. al./HC-CER33
Dearborn National Life Insurance Company 2 Group Dental Insurance 7C-100-1004-MA R608
Dental Service of Massachusetts, Inc. Delta Care DDP-PPA2
Dental Service of Massachusetts, Inc. Delta Dental PPO Options- SP001; SP030; SP032; SP034; SP035; SP036
Dental Service of Massachusetts, Inc. Delta Dental PPO Individual National DDP-PPA6
Dentegra Insurance Company Dentegra Group PPO G-SLE-E-MA-09
Dentegra Insurance Company Delta Dental PPOSM for Ind. & Families I-SLE-C-MA-09
Dentegra Insurance Company Dentegra Individual PPO Plan I-PPO-C-MA-12
Dentegra Insurance Company Dentegra Group PPO Plan G-PPO-E-MA-09
Dentegra Insurance Company of NE
 
AARP Dental Insurance Plan
 
CC-DNNE-MA(DELTAUSA1-2005)D
 
DSM Massachusetts Insurance Company, Inc. Delta Dental Individual and Family EPO DDEPO.SubcInd. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Small Group DDEPO.SubcGrp. 06-14
DSM Massachusetts Insurance Company, Inc. Delta Dental EPO Group MA - Off Exchange DDEPO.Non-ACA.SubcGrp.09-14-14 & MA.EPO.BPR.09.2014
DSM Massachusetts Insurance Company, Inc. Total Choice PPO DD.TCPPO.GRP.LOCAL.012017
First Health Life and Health Insurance Company Dental PPO with DentalGuard Network MHBP01C-MA 0911
(The) Guardian Life Insurance Company of America DentalGuard Preferred CGP-3-DNTL-90-1 et al.
(The) Guardian Life Insurance Company of America Individual Dental Policy - DentalGuard Preferred IP-DEN-12-MA
Humana Insurance Company Dental PPO MA-70146-HC 1/14
The Lincoln National Life Insurance Company
 
Group Dental Insurance GL11/GS12 Series
 
Metropolitan Life Insurance Company Individual Dental Policy IND-DENTAL-2015 & FSD (retiree option)
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic G.23000-13E-MA1
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Classic GCERT2000 den/classic
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value G.23000-13E-MA2
Metropolitan Life Insurance Company MetLife Preferred Dentist Program - Value GCERT2000 den/value
Metropolitan Life Insurance Company PDP Copay Plan G.23000-13EMA3
Metropolitan Life Insurance Company PDP Copay Plan GCERT2000 den/copayrc
MONY Life Insurance Company of America Group Dental Insurance MOEBC15
Principal Life Insurance Company Group Voluntary Dental Expense PPO Plan GC 7000 A (DPPO) et al.
Principal Life Insurance Company Group Dental Expense Ins. Ind/PPO GC 7100
Reliance Standard Life Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Renaissance Life and Health Ins. Co. of America Renaissance Non-EHB Individual Dental Policy INVD-100A-2016-MA
 
Renaissance Life and Health Ins. Co. of America Dental PPO Plan w/ Delta Dental Network INVD-100A-Delta
 
Renaissance Life and Health Ins. Co. of America Renaissance Massachusetts Group Dental Certificate D-2102A-2014-MA, D-202A & D-201A-2014-MA
Standard Insurance Company Certificate Group Dental [and Eye Care] Insurance 9021 MA Rev. 04-13
Starmount Life Insurance Company Group Dental w/DenteMax DN-2015GRPCT-MA
Sun Life Assurance Company of Canada Dental PPO [United Concordia Network] GC-A-1 et al.
Trustmark Insurance Company
 
Group Dental
 
VD0106T/C
 
UniCARE Life and Health Insurance Company Wellpoint Dental PPO CGR 130
Union Security Insurance Company 3 Dental Group Certificate GC-90 et al.
United Concordia Insurance Company Concordia Preferred w Advantage Plus 2.0 MA9804-B (06/17); 9808 0316/9806 0316
United Concordia Insurance Company Concordia Preferred w Elite Plus network MA9804-B (06/17); 9808 0316/9806 0316
United HealthCare Insurance Company Dental Certificate of Coverage DCOC.CER.06 AZ [Rev. 1/06]
United of Omaha Life Insurance Company Group Dental
 
12345GCB-DEN-EZ 13 MA

1Effective December 31, 2012, American General Life Insurance Company of Delaware merged into American General Life Insurance Company.
2 Effective March 1, 2012, Fort Dearborn Life Insurance Company's name changed to Dearborn National Life Insurance Company
3Effective September 6, 2005, Fortis Benefits Insurance Company changed its name to Union Security Insurance Company.
4 Effective December 31, 2016, Security Life Insurance Company of America (“Security Life”) merged into Ameritas Life Insurance Corp (“Ameritas”). Effective January 1, 2017, the Security Life Complete and Advantage Plus plans were no longer marketed in Massachusetts.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company (Form#G-DEN-42002-MA), (The) Principal Life Insurance Company - Dental PPO - Classic & Premier Design (Form# GH 100A (DPPO), Group Voluntary Dental Expense PPO Plan (Form# GC 2000), Insurance PPO Plan (Form# GC 7000) , Group Dental Expense (Form# GC 7200) and United Concordia Insurance Company - Individual Dental Plans (Form#'s MAIN01-0312UCIC & MAIN01-0310UCIC).

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