Welcome Dauntless Industries Employees!
Here's where you can find information about the 
health, dental & life benefits available to you. 

Health

Platinum Access+ HMO $25
Office Visit - $25/$50 copay (Primary Care / Specialist)
Hospital – Inpatient - $250 per day, up to 3 days/admission
$200 copay for Emergency Room (waived if admitted) & $100 for Ambulance
Out-Of-Pocket Max - $2,500 Individual / $5,000 Family
RX copays –$5 Generic / $15 Brand Formulary /$25 Brand Non-Formulary
Silver Access+ HMO $55
Deductible - $1,700 Individual, $3,400 Family
Office Visit - $55/$55 copay (Primary Care / Specialist)
Hospital – Inpatient - 40%
$200 co-pay for Emergency Room (waived if admitted) & $100 for Ambulance
Out-Of-Pocket Max - $6,250 Individual / $12,500 Family
RX Deductible/copays – $300 RX ded. - $15 Generic / $55 Brand Formulary / $75 Brand Non-Formulary
Gold Full PPO 750
Deductible - $750 Individual; $1,500 Family
Office Visit - $20/$35 copay (Primary Care / Specialist)
Hospital – Inpatient - 20%
$100 co-pay for Emergency Room +20% (waived if admitted) & 20% for Ambulance
Out-Of-Pocket Max - $6,250 Individual / $12,500 Family
RX Deductible/copays – $200 RX ded. - $10 Generic / $30 Brand Formulary / $50 Brand Non-Formulary
Silver Full PPO 1250
Office Visit - $30/$60 copay (Primary Care / Specialist)
Deductible - $1250 Individual; $2,500 Family (In/out Combined)
Hospital – Inpatient - 20%
$100 co-pay + 20% (waived if admitted) for Emergency Room and 20% for Ambulance
Out-Of-Pocket Max - $6,250 Individual / $12,500 Family
RX Deductible/copays – $500 RX ded. - $15 Generic / $50 Brand Formulary / $75 Brand Non-Formulary
Silver Full PPO 1700
Office Visit - $40/$50 (Primary Care / Specialist)
Deductible - $1700 Individual / $3,400 Family
Hospital – Inpatient - 30%
$200 co-pay + 30% (waived if admitted) for Emergency Room & 30% for Ambulance
Out-Of-Pocket Max - $6,250 Individual / $12,500 Family
RX Deductible/copays – $300 RX ded. - $15 Generic / $50 Brand Formulary / $75 Brand Non-Formulary
Bronze Full PPO 3000
Office Visit - $60/$70 (Primary Care / Specialist)
Deductible - $3000 Individual/ $6,000 Family
Hospital – Inpatient - 15%
$100 co-pay (waived if admitted) then 70% after ded. for Emergency Room & 70% after ded. for Ambulance
Out-Of-Pocket Max - $6,250 Individual / $12,500 Family
RX Deductible/copays – after medical ded. - $15 Generic / $50 Brand Formulary / $75 Brand Non-Formulary

    How do I determine my cost?
    Fill out this form and we'll get back to you with age-based rates for you and any dependents.

Medical Enrollment Form

Find a Provider
​with Blue Shield!

Please return all completed enrollment forms to Bill Graham
Fax: (714) 979-2809
Email: billg@aclevidence.com

Once you've submitted your paperwork, 
your ID cards should arrive within 7-10 business days. 
Need to print a temporary ID card now?


Download Blue Shield's mobile app 
to access plan benefits and claims, search for a doctor, and view ID card information.

Dental

Dental PPO 100/90/60 $2000 CYM

​In Network- 
      Preventative Services: 100%
        Basic Services: 90%
        Major Services: 60%
        $2000 Calendar Year Maximum

Dental Enrollment Form

Dental Plan Rates

Find a Dentist 
with MetLife!

Life and AD&D

$15,000 Basic Life and AD&D

Life Enrollment Form

Life and AD&D Rates

Subscribe
to our quarterly health and wellness newsletter!

Have questions about the plans available to you?

Please contact Ashbrook Clevidence with any questions regarding your current benefits and the insurance options available to you. 

Call us at (714) 755-2485!