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Dental Insurance Quote

 Request a quote for group dental insurance today.

Solera Insurance & Financial Services, Inc.
4251 S. Natches Court, Suite C
Sheridan, Colorado 80110
Voice: 720-279-7400

Fax: 866-914-5429

 

Group Dental Insurance Quote Form:

This form is a quote request designed to assist you in finding the right dental insurance plan.  To get an accurate quote and to best match your needs, please provide as much information as possible below. 

* Required Information.

Broker Information

First Name:

   Last:

Agency Name:
Phone:
Email:

Client Information

First Name:

   Last:

* Company Name:

* SIC Code:

      * Effective Date: 

* Total Employees:

      Number of Employees on Current Plan:

Phone:

Email:

Street:

City, ST:

 ,

 * Zip:

                Existing Dental Insurance?Yes  No

Existing Plan Information

Current Carrier:

In-Network:

 Prev:%   Diag:%   Basic:%   Major:%   Ortho:%

Out-of-Network:

 Prev:%   Diag:%   Basic:%   Major:%   Ortho:%

Deductible:

 $   Annual Ded.    Lifetime Ded.    Waived for Prev/Diagnostic

Annual Maximum:

 $ per person per year

Ortho Maximum:

 $ per person lifetime

Current Rates:

 EE: $   EE/Spouse: $   EE/Children: $   Family: $

Renewal Rates:

 EE: $   EE/Spouse: $   EE/Children: $   Family: $
Contribution: Employer Pays for EE     Employer Contributes for EE     100% Voluntary

Goals for the new Dental Plan:

 Priorities for Employer:  Lower Rates     More Options     Increase Benefits     Change Carriers

 Would employer consider contributing to the plan if it would lower rates?  Yes     No

 I am interested in:  Dental Quote     Vision Quote     Life Quote     Disability

Additional Comments or Requests:


If you have a census, please email it to agent.services(at)SoleraInsurance.com

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