SmartSmile^sm Dental Plans

Please use the following links to download PDF versions of our brochures and plan documents for benefits available in your state.

California

• California Evidence of Coverage Supplement
• SmartSmile and Super SmartSmile CA
• SmartSmile Copayment Schedule and Exclusions and Limitations
• Super SmartSmile Copayment Schedule and Exclusions and Limitations
• California Individual Evidence of Coverage

Oregon

• 2025 Brochure
• 2025 OR Enrollment Form QDP
• 2025 SmartSmile-EC Evidence of Coverage OFF Exchange
• 2025 SmartSmile-EC Evidence of Coverage ON Exchange
• 2025 OR-822i Oregon Member Copayment Schedule (SmartSmile)
• 2025 OR-823i Oregon Member Copayment Schedule (Super SmartSmile)
• 2025 OR-824i Oregon Member Copayment Schedule (SmartSmile)

Washington

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If English is your secondary language, you may obtain this information written in your language. Please call a Member Services Specialist at 866.756.4259 or toll-free at TTY line 711 for the hearing and speech impaired.

IMPORTANTE: Si Ingles es su Segundo idioma, usted podria obtener esta información escrita en su propio idioma. Para ayuda gratuita, llame a su Especialista de Membrecia al 866-756-4259. O a la linea gratuita TTY 711 para personas con necesidades de audicion y habla.