We offer a wide selection of group dental insurance plans. Please fill out the form and a representative will get back to you with the best group dental plan available for your company.
*First Name:
*Last Name:
Company:
Title:
Street Address:
Address 2:
City:
State:
Zip Code:
Phone:
- -
Fax:
*E-mail:
Section 2 Please enter the company information:
Company Name:
Company Address:
Where is the company's home office?
Is this where the benefit buying decision is made?
Yes No
If "No", where is the decision made?
What is the company's SIC Code?
SIC Code:
What is your estimate of the total employees and family members?
Employees:
Add'l Family Members:
Does the company currently offer a dental benefit to its employees?
If you answered "No" above, please skip to section 5.
Section 4 If you answered YES, then:
Please indicate the type of plan currently offered: (check all that apply)
Traditional indemnity
Preferred Provider
Dental HMO
Is this a voluntary program or does the company pay all or part of the benefit?
Voluntary
Employer pays all
Employer/Employee contribution
When does the contract with the current carrier expire?
Date:
Who is the current carrier?
Name:
Why are you looking for a new dental benefits carrier? (check all that apply)
Dissatisfied with service
More plan options needed
Company policy to re-bid
Better cost/value
Larger network needed
Other
How soon will you need a formal bid response?
Section 5 If you answered NO, then:
What type of dental benefits plan are you interested in?
How soon would you like the program in place?
Section 6 Is there anything else you would like to tell us about the company?
Section 7 The Census Please copy and paste the details of your employes or e-mail us the file.
Please provide the following information for each employee to be quoted in this group policy: • First and Last Name of each person • ZIP Code where the employee resides • Birth Date and Gender • Spouse/Children: whether the employee's spouse and/or children should be included in the quote
First Name | Last Name | ZIP | DOB | Gender | Spouse | Children
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Related Articles
Dental insurance for life and other major events Insurance for teeth is super important individual dental insurance for suburbanites Family dental insurance can really save you money Large familydental insurance can really help you We'll help you find a dentist we can help you with dental mental coverage it is true that health and dental insurance save money with a discount dental plan discount dental plans can really help you out cheap dental insurance is what most people are looking for Individual and small company dental plan Individual dental plans are not just for groups Dental care will give you a better smile It is our goal to find you an affordable dental plan affordable dental plans will make you happy Affordable deep discount dental insurance is here family dental is the plan that we all need family dental plans are great for a good laugh family dental careless wories discount dental worries are a thing of the past
