Benefit Schedules

• Plan 100 Schedule

• Plan 300 Schedule

• Plan 303 Schedule
• Plan 340 Schedule
• Plan 395 Schedule
• Plan 404 Schedule
• Plan 411 Schedule
• Plan 430 Schedule
• Plan 460 Schedule (Group)
• Plan 460 Schedule (Individual)
• Plan 465 Schedule (Individual)
• Plan 465 Schedule (Group)
• Plan 495 Schedule
• Plan 501 Schedule
• Plan 505 Schedule
• Plan 530 Schedule
• Plan 595 Schedule
• Plan 600 Schedule
• Plan 665 Schedule


• UABT Basic Schedule
• UABT Choice Schedule
• UABT Prime Schedule
• Advantage Plan 75 Schedule
• Advantage Plan 100 Schedule
• Advantage Plan 150 Schedule
• Advantage Plan 200 Schedule
• Advantage Plan 250 Schedule

Provider Directories

• Northern California
• Southern California

Broker Forms

• Agent Appointment/Contracting Papers
• Agent Supply Request
• Request for Proposal
• Advertising Buck Slip (With editable contact information)
• Don't Be Fooled By A Discount Plan

For Individuals

• Plan 411 Brochure
• Plan 460 Brochure
• Plan 595 Brochure
• Enrollment Form
• GRIEVANCE FORM

For Providers

• Specialist Referral
• Patient Encounter Form
• Facility Information Sheet
• General Dentist Contracting Kit
• Orthodontist Agreement
• Specialist Agreement
• Upgrade/Optional Treatment Form

Spanish Forms

• Lista de Beneficios Advantage 75
• Lista de Beneficios Advantange 100
• Lista de Beneficios Advantage 150
• Lista de Beneficios Advantage 200
• Lista de Beneficios Advantage 250
• Forma de Queja
• La Combinación de La Evidencia de Cobertura y Forma de Divulgación para el Acuerdo Individual del Suscriptor