Forms & Documents

Summary of Benefits (SOB)

Chiro/Acu: Landmark

	Acupuncture Schedule of Benefits $10 20 Plan Highlights
	Acupuncture Schedule of Benefits $10 20 Plan Highlights
	Acupuncture Schedule of Benefits $10 30 Plan Highlights
	Acupuncture Schedule of Benefits $10 30 Plan Highlights
	Acupuncture Schedule of Benefits $15 20 Plan Highlights
	Acupuncture Schedule of Benefits $15 20 Plan Highlights
	Acupuncture Schedule of Benefits $15 30 Plan Highlights
	Acupuncture Schedule of Benefits $15 30 Plan Highlights
	Acupuncture Schedule of Benefits $20 20 Plan Highlights
	Acupuncture Schedule of Benefits $20 20 Plan Highlights
	Acupuncture Schedule of Benefits $20 30 Plan Highlights
	Acupuncture Schedule of Benefits $20 30 Plan Highlights
	Acupunture Schedule of Benefits $35 10 Plan Hightlights
	Acupunture Schedule of Benefits $35 15 Plan Hightlights
	Acupunture Schedule of Benefits $35 20 Plan Hightlights
	Chiropractic Schedule of Benefits $10 20 Plan Highlights
	Chiropractic Schedule of Benefits $10 20 Plan Highlights
	Chiropractic Schedule of Benefits $10 30 Plan Highlights
	Chiropractic Schedule of Benefits $10 30 Plan Highlights
	Chiropractic Schedule of Benefits $15 20 Plan Highlight
	Chiropractic Schedule of Benefits $15 20 Plan Highlights
	Chiropractic Schedule of Benefits $15 30 Plan Highlights
	Chiropractic Schedule of Benefits $15 30 Plan Highlights
	Chiropractic Schedule of Benefits $20 20 Plan Highlight
	Chiropractic Schedule of Benefits $20 20 Plan Highlights
	Chiropractic Schedule of Benefits $20 30 Plan Highlights
	Chiropractic Schedule of Benefits $20 30 Plan Highlights
	Chiropractic Schedule of Benefits $25 10 Plan Highlights
	Chiropractic Schedule of Benefits $25 15 Plan Highlights
	Chiropractic Schedule of Benefits $25 20 Plan Highlights
	Combined Schedule of Benefits $10 20 Plan Highlights
	Combined Schedule of Benefits $10 20 Plan Highlights
	Combined Schedule of Benefits $10 30 Plan Highlights
	Combined Schedule of Benefits $10 30 Plan Highlights
	Combined Schedule of Benefits $15 20 Plan Highlights
	Combined Schedule of Benefits $15 20 Plan Highlights
	Combined Schedule of Benefits $15 30 Plan Highlights
	Combined Schedule of Benefits $15 30 Plan Highlights
	Combined Schedule of Benefits $20 20 Plan Highlights
	Combined Schedule of Benefits $20 20 Plan Highlights
	Combined Schedule of Benefits $20 30 Plan Highlights
	Combined Schedule of Benefits $20 30 Plan Highlights
	Landmark Chiropractic Only Expanded Evidence of Coverage
	Landmark Chiropractic Only Standard Evidence of Coverage
	Landmark Combined Expanded Evidence of Coverage
	Landmark Combined Standard Evidence of Coverage

Dental HMO: Delta Dental

	CoPower ONE DeltaCare Voluntary Highlights
	DHMO Advantage 15B SOB
	DHMO Core 17B SOB
	DHMO Deluxe 11A SOB

Dental HMO: MetLife

	MetLife 5-50 DHMO MET100 Summary of Benefits
	MetLife 5-50 DHMO MET150A Summary of Benefits
	MetLife 5-50 DHMO MET185A Summary of Benefits
	MetLife 5-50 DHMO MET225 Summary of Benefits
	MetLife 5-50 DHMO MET245 Summary of Benefits
	MetLife 5-50 DHMO MET290 Summary of Benefits
	MetLife 5-50 DHMO MET335 Summary of Benefits
	MetLife 5-50 DHMO MET85 Summary of Benefits
	MetLife 5-50 DHMO METCO1C Summary of Benefits
	MetLife 5-50 DHMO METCO2C Summary of Benefits
	MetLife 5-50 DHMO METCO3C Summary of Benefits
	MetLife 5-50 DHMO METCO4C Summary of Benefits
	MetLife 5-50 DHMO METCO5C Summary of Benefits
	MetLife 5-50 DHMO METCO6C Summary of Benefits
	MetLife 5-50 DHMO METCO7C Summary of Benefits
	MetLife 5-50 DHMO METCO8C Summary of Benefits
	Metlife_DHMO.doc

Dental PPO w/Ortho: Delta Dental

	Choice PPO $1,000 with Ortho Plan Highlights
	Choice PPO $1,000 without Ortho Plan Highlights
	Choice PPO $1,500 with Ortho Plan Highlights
	Choice PPO $2,000 with Ortho Plan Highlights
	Choice PPO $2,000 without Ortho Plan Highlights
	Choice Premier $1,000 with Ortho Evidence of Coverage
	Choice Premier $1,000 with Ortho Evidence of Coverage
	Choice Premier $1,000 with Ortho Plan Highlights
	Choice Premier $1,500 with Ortho Evidence of Coverage
	Choice Premier $1,500 with Ortho Evidence of Coverage
	Choice Premier $1,500 with Ortho Plan Highlights
	Choice Premier $2,000 with Ortho Evidence of Coverage
	Choice Premier $2,000 with Ortho Evidence of Coverage
	Choice Premier $2,000 with Ortho Plan Highlights
	PPO Advantage 400 | $1000 Max | $1000 Ortho SOB

Sales Guides & Flyers

Brochures/Flyers: Broker/Employer

CoPower SELECT Landmark Summary of Benefits and Rate Guide

Product Guides

CoPower ONE Product and Rate Guide 2024 - California