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Employee & Dependent Roster
Enter each employee and any family members needing coverage
1 Employee • 1 Total Life
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Delta Dental of Idaho — 2026 Flex Plan
Bundle of 4 plans tailored for employer groups (2-99 eligible employees)
Scroll table horizontally to view all plans
Plan Features & Coinsurance
PPO Preventive
PPO $1,250
PPO $1,500 Child Ortho
PPO $3,000 Adult & Child Ortho
Preventive & Diagnostic Services
100% PPO / 80% Premier
100% PPO / 80% Premier
100% PPO / 80% Premier
100% PPO / 80% Premier
Basic Services
0% PPO / 0% Premier
80% PPO / 70% Premier
80% PPO / 70% Premier
80% PPO / 70% Premier
Major Services
0% PPO / 0% Premier
50% PPO / 40% Premier
50% PPO / 40% Premier
50% PPO / 40% Premier
Deductible (Per person / Per family)
$0
$50 / $150
$50 / $150
$50 / $150
Annual Maximum
No max
$1,250 PPO / $1,000 Premier
$1,500 PPO / $1,000 Premier
$3,000 PPO / $1,000 Premier
Orthodontia Coverage
N/A
N/A
50% (Child Only)
50% (Adult & Child)
Orthodontia Lifetime Maximum
N/A
N/A
$1,500
$2,000
Monthly Rates (1-Year Period)
Employee
$23.74
$48.46
$52.91
$73.99
Employee + Spouse
$47.49
$96.93
$105.82
$143.26
Employee + 1 Child
$44.78
$91.38
$107.86
$136.05
Employee + 2 or More Children
$55.71
$113.80
$147.58
$181.46
Employee + Spouse + 1 or More Children
$77.82
$158.93
$196.86
$240.09
Rates listed above are valid until 12/31/2026. Rates are for a one (1) year period. Available in the Community Pool for groups with 2-99 eligible employees.
Preventive & Diagnostic
Routine and emergency exams, X-rays, teeth cleanings, sealants.
Basic Services
Fillings, periodontal cleanings, root canals, minor oral surgery.
Major Services
Crowns, onlays, bridges, dentures, implants — lifetime implant benefit up to $1,200 per tooth or plan's annual maximum, whichever is less.
Deductible
Only applies to basic and major services; maximum of three deductibles per family; annual per person/family.
Orthodontia
Child only orthodontic plans are for dependent children with banding up to age 19. Adult and child orthodontic plans are for enrolled members of any age.
Orthodontic Lifetime Maximum
The amount your dental plan will contribute to your orthodontia over the course of your lifetime. Replacement of orthodontic appliance is not covered.
Voluntary/Non-Voluntary Status: The Flex Plan rates are the same regardless of voluntary or non-voluntary status, or employer contributions towards premiums.
Minimum Group Size: Groups must maintain a minimum of two (2) enrolled employees.
Minimum Enrollment: Minimum enrollment of 35% of the eligible employees is required.
Residency Requirement: A group must consist of 75% or more of Idaho residents or a surcharge may apply.
Secretary of State Registration: Companies must be registered as a business with the Idaho Secretary of State.
Previous Deductible Credit: The previous deductible will be honored providing the covered employee has proof of the deductible being taken during the calendar year, and prior to enrollment with Delta Dental.
Termination of Coverage: Coverage will terminate for an eligible employee on the last day of the month in which employment terminates.
Industry Restrictions: Due to high turnover trends and/or lack of employee/employer relationship, some industries, such as restaurants, gas stations, insurance (commissioned agents), hotel, motel, retail, beauty/barber shops, and real estate (commissioned agents), are restricted and may deviate from eligibility and underwriting requirements. Dental offices are not eligible for group policies.
Late Enrollee Provision: Any employee and/or their dependent(s) who do not enroll in the dental plan following completion of the employee's eligibility period, or during the group policy's annual open enrollment period, or with a qualifying event, will have a 12-month waiting period for Major Services and, if applicable, Orthodontic Services.
In addition to any other limitations & exclusions of the group dental policy, the following apply to dental services:
Those benefits excluded by the policies and procedures of Delta Dental.
Processing Policies may limit treatment based on generally accepted standards of dental practice.
Services or appliances started before an individual became eligible under this Contract.
Delta Dental's obligation for payment for covered services ends on the last day of the month in which coverage is terminated.
Delta Dental is not obligated to pay claims received more than 12 months after the date of rendition of the service.
Treatment by other than a Dentist, except for services performed by a licensed dental hygienist or denturist within scope.
Services or supplies for which no charge is made, or for which the patient is not legally obligated to pay.
Services for cosmetic surgery or dentistry for aesthetic reasons, unless listed as a covered benefit.
Optional treatment: subscriber pays difference if a more expensive dental service is selected.
Interrupted services completed later by another dentist will be reviewed for appropriate payment allocation.
Services covered under a hospital, surgical/medical, or prescription drug program.
Services for which no valid dental need can be demonstrated, specialized techniques, or experimental procedures.
Prescription drugs, pre-medications, and general anesthesia/sedation (except covered oral surgery).
Appliances, restorations, or services for diagnosis or treatment of TMJ disturbances.
Myofunctional therapy and preventive control programs including home care items.
Charges for failure to keep a scheduled visit with the Dentist.
Lost, missing, or stolen appliances of any type.
Services for injuries payable under Workers' Compensation or government agency (Title XIX Medicaid exempt).
Services or supplies received as a result of defect or injury due to an act of war, declared or undeclared.
Dependent children are eligible up to age 26.
Child-only orthodontic benefits are eligible for dependent children with banding up to age 19.
United Heritage & VSP Vision Care — 2026
Rates guaranteed for 1 year for Group Vision Coverage
Scroll table horizontally to view all rates
Non-Voluntary Rates (100% Employer Paid)
$10 exam copay / $25 materials copay
Plan Type
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
Plan A (12 / 12 / 12 Months)
$10.22
$20.44
$21.87
$34.96
Plan B (12 / 12 / 24 Months)
$8.10
$16.19
$17.32
$27.68
Voluntary Rates
$10 exam copay / $25 materials copay
Plan Type
Employee Only
Employee + Spouse
Employee + Child(ren)
Employee + Family
Plan A (12 / 12 / 12 Months)
$12.73
$25.45
$27.23
$43.52
Plan B (12 / 12 / 24 Months)
$10.08
$20.17
$21.57
$34.48
Scroll table horizontally to view all allowances
Benefit Item
VSP Choice Preferred Provider
Open Access Allowances
WellVision Exam
Covered after copay (Every 12 Months)
$45 Allowance
Single Vision Lenses
Covered after copay
$30 Allowance
Lined Bifocal Lenses
Covered after copay
$50 Allowance
Lined Trifocal Lenses
Covered after copay
$65 Allowance
Frame Allowance
$200 Allowance
$70 Allowance
Elective Contact Lenses*
$200 Allowance
$105 Allowance
*Contact lenses are in lieu of lenses and frames.
VSP Choice Plan A
Exam: Every 12 Months
Lenses: Every 12 Months
Frame: Every 12 Months
VSP Choice Plan B
Exam: Every 12 Months
Lenses: Every 12 Months
Frame: Every 24 Months
Delta Dental of Idaho — Individual & Family Plans
Plan Comparison, Benefit Schedule & Frequently Asked Questions
*Waiting periods may apply unless prior credible coverage is verified.
Who can purchase a plan?
Coverage is available to all permanent residents of Idaho. Spouses and/or dependent children are also eligible. Coverage can be purchased by individuals, two-person households, or families.
Can I use my own dentist?
With our dental plans, you likely can—9 out of 10 dentists nationwide are in our network, making it easy to keep the dentist you already know and trust.
What happens when I travel?
Delta Dental coverage goes wherever you go, in or out of Idaho, even with college students as they travel across the country. You’ll have peace of mind knowing your dental needs are covered!
Do I have to wait to have major procedures covered?
If you’ve had at least 12 months of prior dental coverage with no more than a 30-day lapse, all waiting periods are waived. Have you been without coverage for more than 30 days? No problem! Our Clear Plan offers comprehensive coverage with no waiting periods—so you can get the care you need right away.
How soon can I have coverage?
You can enroll at any time through the end of the month, and your coverage will begin on the 1st of the following month.
Can I get dental coverage if I am part of a Medicare plan?
Yes. Delta Dental plans are a smart choice to fill dental coverage gaps in Medicare plans. Medicare Parts A and B exclude routine dental care and Medicare Advantage plans vary greatly in the amount of dental coverage they provide. Medicare annual enrollment periods don’t apply to dental coverage from Delta Dental, so you can enroll with us any time.
Qualifying Life Event (QLE) Proof & Documentation Guide
Requirements to verify your Special Enrollment Period so coverage begins on the 1st of the month
Coverage Starts the 1st of the Month
When you experience a Qualifying Life Event, you qualify for a Special Enrollment Period (SEP). Your health insurance will take effect on the 1st day of the upcoming month following your application and verification. Documentation must typically be submitted within 60 days of the qualifying event date.
Acceptable Documents by Life Event Scenario
Loss of Employer-Sponsored Coverage
(Job change, reduction in hours, resignation, termination, or retirement)
Required Documentation: Letter of Creditable Coverage, termination notice on official company letterhead signed by HR, or COBRA notification letter specifying the employee and dependents' names and the exact date coverage ended.
Loss of Medicaid or CHIP
(Income changes, redetermination unwinding, or change in eligibility)
Required Documentation: Idaho Department of Health and Welfare (IDHW) Notice of Action or closure letter showing member name(s) and exact date Medicaid ended (you have up to 90 days from the loss date to enroll).
Turning 26 (Aging off Parent's Plan)
(Loss of dependent status on parent's group or individual health plan)
Required Documentation: Letter from the parent's employer HR department or insurer indicating that coverage is terminating due to age limit, including the dependent's name and cancellation date.
Baby Was Born, Adoption, or Foster Care
(Addition of a new child dependent to your household)
Required Documentation: Official birth certificate, official hospital birth record/souvenir record showing parent and child names, or legal court placement / adoption papers. Coverage can be made retroactive to the date of birth or start 1st of following month.
Divorce, Legal Separation, or Marriage
(Change in marital status resulting in loss or gaining of coverage eligibility)
Required Documentation: Signed court divorce decree or legal separation agreement showing dissolution date and loss of coverage; or official state marriage certificate.
Moving from a Different State or County
(Permanent relocation that makes new health plan options available in Idaho)
Required Documentation: Proof of prior qualifying health insurance for at least one day in the 60 days before moving PLUS proof of your new Idaho address (lease agreement, utility bill, mortgage statement, or Idaho driver's license).
Death in the Family
(Loss of primary subscriber or family member affecting plan eligibility)
Required Documentation: Certified death certificate, formal letter from an estate or funeral home, or insurance policy termination notice indicating death of subscriber.
Select Health — Short-Term Transitional Plans (Idaho)
Nonrenewable Limited-Duration Coverage (30 Days to 12 Months) • Med Network
Summary of Benefits & Payment Comparison: Select Health offers two transitional deductible tiers under the Med Network in Idaho. Both plans provide immediate hospitalization and doctor visit protection while waiting for ACA Open Enrollment.
Scroll table horizontally to compare plans
Plan Benefit & Coverage Provision
Option 1: $2,500 Deductible Plan ID: 133G0001 (Select Health Med Network)
Option 2: $4,000 Deductible Plan ID: 133G0002 (Select Health Med Network)
Calendar Year Deductible Per Calendar Year (Individual / Family)
$2,500 / $5,000
$4,000 / $8,000
Out-of-Pocket Maximum Per person (Deductible + Coinsurance + Copay)
$5,000
$4,600
Medical Coinsurance What you pay after deductible is met
20% after deductible
50% after deductible
Lifetime Maximum Plan Payment
$1,000,000
$1,000,000
Primary Care (PCP) Virtual Visits Intermountain Connect Care®
Tier 1: $10 copay Tier 2: $35 after Rx ded. Tier 3: 25% after Rx ded. Tier 4 & 5: 50% after Rx ded.
Tier 1: $10 copay Tier 2: $35 after Rx ded. Tier 3: 25% after Rx ded. Tier 4 & 5: 50% after Rx ded.
Pre-Existing Conditions (PEC)
Not Covered
Not Covered
Noncovered Services
Maternity, adoption, routine preventive care, immunizations, infertility, mental health, substance use disorder.
An Ideal Solution For:
Nonrenewable Short-term Limited Duration plans are specifically tailored to help cover accidents and illnesses for a defined period of time:
Waiting for Group CoverageEmployees in a 30 to 90-day waiting period for new employer benefits to take effect.
Missed Open EnrollmentIndividuals who missed the annual ACA enrollment window and lack a qualifying life event.
Between Jobs or Laid OffJob seekers needing temporary protection without paying costly COBRA premiums.
Recent GraduatesHigh school or college grads transitioning into the workforce or starting independent careers.
New Business OwnersEntrepreneurs starting a new business needing affordable protection until revenues ramp up.
Aged Off Parent's PlanYoung adults who recently turned 26 and need transitional bridge coverage.
4 Simple Steps to Apply
1
Choose Deductible
Select either the $2,500 deductible (20% coinsurance) or $4,000 deductible (50% coinsurance) option.
2
Select Payment Method
Single payment via credit/debit card or electronic check, or monthly preauthorized checking withdrawal.
3
Estimate Premium
Work with Parker Insurance or calculate online to view your exact monthly rate based on age.
4
Submit Application
Sign and submit your application. Coverage can begin as soon as the very next calendar day!
Important Notice Regarding Short-Term Limited-Duration Insurance
This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits.
Term Length & Non-Renewability:
The minimum plan term is 30 days, and the maximum plan term is up to 12 months. All plans terminate on December 31 of the same year they are activated. You will not be able to renew your plan after the term ends; however, you may reapply for another policy after a 63-day waiting period.
Exclusions:
Short-term Limited Duration plans are not guaranteed issue and do not cover preventive care, mental health, maternity, or pre-existing conditions (any medical condition diagnosed or treated within 6 months prior to enrollment).
Loss of Short-Term Coverage Does NOT Trigger an ACA SEP:
If this coverage expires or you lose eligibility for this coverage, you might have to wait until the annual Open Enrollment period (October 15 – December 15) to get ACA comprehensive health insurance.
Blue Cross of Idaho — Access Individual Application Disclosure
Coverage Disclosures & Application Guidelines • Form No. 20-053
IMPORTANT: This is a short-term, limited-duration policy, NOT comprehensive health coverage.
This is a temporary, limited policy that has fewer benefits and federal protections than other types of health insurance options, like those on HealthCare.gov.
Scroll table horizontally to view comparison
THIS POLICY
INSURANCE ON HEALTHCARE.GOV
Might not cover you due to preexisting health conditions like diabetes, cancer, stroke, arthritis, heart disease, mental health & substance use disorders
Can't deny you coverage due to preexisting health conditions
Might not cover things like prescription drugs, preventive screenings, maternity care, emergency services, hospitalization, pediatric care, physical therapy & more
Covers all essential health benefits
Might have no limit on what you pay out-of-pocket for care
Protects you with limits on what you pay each year out-of-pocket for essential health benefits
You won't qualify for federal financial help to pay premiums & out-of-pocket costs
Many people qualify for federal financial help
Doesn't have to meet federal standards for comprehensive health coverage
All plans must meet federal standards
This coverage is not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. Be sure to check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of preexisting conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health and substance use disorder services). Your policy might also have lifetime and/or annual dollar limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.
Looking for Comprehensive Health Insurance?
Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options. To find out if you can get health insurance through your job, or a family member's job, contact the employer.
Questions About This Policy?
For questions or complaints about this policy, contact the Idaho Department of Insurance. Find their number on the National Association of Insurance Commissioners' website (naic.org) under "Insurance Departments."
Parker Insurance Appointed Agent Signature Required
Blue Cross of Idaho requires that Section 13 (Agent Information) of this 7-page application be signed and verified by a licensed, appointed agent. You cannot submit this application alone. Parker Insurance will assist you in completing, signing, and submitting the entire package at 100% no cost.
Overview of Application Sections (Form No. 20-053):
Section 1 • Enrollment InfoNew applicant vs dependents, state residency check, requested effective date.
Comparison Guide for Original Medicare (Parts A & B), Medigap (Plan G), Part D, Medicare Advantage (Part C), and MSA
Quick Comparison: Compare how Original Medicare pairs with supplemental coverage versus all-in-one Medicare Advantage alternatives. All dollar figures reflect 2026 benchmark amounts.
Scroll table horizontally to compare all 5 options
Feature
Original Medicare (Parts A & B)
+ Medigap (Plan G)
+ Part D (Rx Coverage)
Medicare Advantage (Part C)
Medicare MSA (Savings Account)
Run By
Federal government
Private insurer (supplemental)
Private insurer
Private insurer
Private insurer
Deductible
$1,736 / event (A) + $283 (B)
Covers Part A deductible; only $283 Part B deductible remains
~$615 standard ($0 on most generics)
Varies by plan (often $0 drug/med ded)
High deductible (varies by carrier)
Coinsurance
20% for Part B (UNCAPPED)
$0 / N/A (Plan G covers 100%)
Copays by drug tier
Copays vary by service & plan
N/A until high deductible met
Monthly Cost
$202.90+ (Part B base; income-based)
~$265 / mo (approximate estimate)
Plan premium (varies by carrier)
Varies by plan ($0 premium plans available)
Varies by plan
Out-of-Pocket Max
None built-in
Capped at $283 (Part B ded only)
$2,100 cap (2026 covered Rx cap)
Built-in maximum (varies by plan)
N/A
Provider Networks
None • Any doctor taking Medicare nationwide
None • Any doctor taking Medicare nationwide
Pharmacy networks
HMO / PPO networks (Must use in-network doctors for HMO)
None until deductible met
Prescription Drugs
Add Part D separately
Add Part D separately
Included • Stand-alone drug plan
Usually bundled (MAPD plans)
Add Part D separately
Extra Benefits (Dental, Vision, Hearing)
No
No
No
Often Yes (dental, vision, hearing, gym)
No
Reference Note: This is a plain-language educational summary. Costs shown (Part B $202.90 premium, Part A $1,736 deductible, etc.) are 2026 figures. A licensed Parker Insurance agent will verify exact plan rates, formularies, and provider networks for your county.
Deep Dive into Medicare Coverage: Review exactly what each part of Medicare pays, what it costs, and how supplemental coverage shields your retirement savings.
Medicare Part A
Hospital Insurance
Covered Care: Inpatient hospitalization, skilled nursing facilities, hospice care, lab tests, surgery, home health care.
Monthly Premium:$0 / No cost if you have worked at least 40 quarters (10 years) in your lifetime.
Deductible:$1,736 per event / benefit period (can occur multiple times per year).
Days 1–60: $0 coinsurance after meeting Part A deductible.
Days 61–90:$434/day coinsurance per day of benefit period.
Days 91+:$868/day coinsurance while using 60 lifetime reserve days.
Medicare Part B
Medical Insurance
Covered Care: Doctor appointments, outpatient surgery, durable medical equipment (DME), diagnostic scans, and preventive screenings.
Monthly Premium:$202.90 for 2026 (higher for high-income earners via IRMAA).
Annual Deductible:$283 per year.
Coinsurance:20% coinsurance for Medicare-approved doctor and outpatient services.
The Big Risk: Original Medicare has NO out-of-pocket maximum. A $100,000 cancer treatment could leave you responsible for $20,000 without supplemental coverage!
Medigap (Plan G)
Supplemental Insurance
What It Covers: Covers 100% of the Part A deductible ($1,736) and 100% of Part B coinsurance (20%).
Your Only Out-of-Pocket Expense: Leaves only the $283 Part B deductible per year. Once met, 100% of covered medical bills are paid!
Total Doctor Freedom: Accepted anywhere in the US that accepts Medicare. No network limits, no specialist referrals.
Cost: Approximately ~$265/month (varies by age, gender, and zip code).
Medicare Part D
Prescription Drug Coverage
Plan Type: Stand-alone prescription drug plan through private insurers. Pair with Original Medicare and Medigap Plan G.
Deductible: Standard deductible is ~$615. Most plans offer $0 deductible for generic prescriptions.
Out-of-Pocket Cap:$2,100 maximum out-of-pocket on covered prescriptions in 2026. Once you reach $2,100, you pay $0 for covered drugs the rest of the calendar year!
Medicare Advantage (Part C)
All-in-One Private Alternative
Bundled Structure: Combines Part A, Part B, and usually Part D through a private carrier. Replaces Original Medicare (it is an alternative, not an add-on).
Extra Perks: Often includes routine dental, vision, hearing, over-the-counter allowances, and gym memberships.
Network Rules: In HMO plans, you must use in-network doctors and clinics (except emergencies). Copays apply for each doctor visit or hospital stay up to an annual maximum out-of-pocket limit.
Medicare MSA
Medical Savings Account Plan
Specialized Structure: High-deductible Medicare Advantage plan paired with a savings account.
Carrier Contribution: The plan contributes funds into an MSA account to help pay for medical care.
Provider Freedom: Can see any doctor that accepts Medicare.
No Rx Coverage: Does not include prescription drugs — must be paired with a stand-alone Part D plan. No services are covered prior to reaching the high deductible.
Working Past Age 65: If you or your spouse have active group health insurance through an employer, you can coordinate your coverage smoothly and avoid lifetime late enrollment penalties.
1. Employer Size Rules (20+ vs. Under 20 Employees)
If your company has 20 or more employees, group health is primary and you can safely delay Medicare Part B without any late enrollment penalty. If your employer has fewer than 20 employees, Medicare is primary, meaning you must enroll in Part A and Part B at age 65 to prevent coverage gaps.
2. Form CMS-L564: Request for Employment Information
When you eventually retire or drop employer coverage, you have an 8-month Special Enrollment Period (SEP) to enroll in Part B. Your employer must fill out Section B of form CMS-L564 to verify continuous credible group coverage. Submitting this form guarantees you pay zero late penalties.
3. Compare Group Costs vs. Medicare
Many employees over 65 find that high employee payroll deductions, $3,000–$6,000 deductibles, and family copays cost far more than Medicare. Parker Insurance will calculate an exact cost comparison between staying on group coverage versus switching to Medicare + Medigap Plan G or Medicare Advantage.
