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3-Tier Large Group Plan Preferred Drug List (employers with 51+ employees)
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Dental Provider Guide
AYS Claims Reconsideration Submission Instructions (PDF)
AYS Paperless (PDF)
Claim Reconsiderations (PDF)
D5 INSADO PPO 27 Adult Coverage Plan (PDF)
Dental Anesthesia for Children ASC Changes (PDF)
Dental Benefit Schedule SHL PPO (PDF)
DLVPP 14 (PDF)
DLVPP 100 (PDF)
DLVPP 304 (PDF)
DLVPP 400 (PDF)
Embedded Pediatric Dental PPO Breakdown (PDF)
Endodontic Dental Fee Schedule (PDF)
Frequency Limitations Grids SHL SHO (PDF)
General Dentistry Fee Schedule (PDF)
Medical Prior Auth Form (PDF)
Northern Nevada General Dentistry Dental Fee Schedule (PDF)
Oral Surgery Dental Fee Schedule (PDF)
Orthodontic Fee Schedule (PDF)
Pediatric Dental Fee Schedule (PDF)
Periodontic Fee Schedule (PDF)
SHL Co-Insurance Grid (PDF)
SHL PPO 28 Plan (PDF)
SHL PPO 29 Plan (PDF)
