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Forms FAQs

Choose your state to find the correct forms

Here are a few answers to the most common questions

  • How do I request agent materials?

    You can request information and materials to sell our products by:

    • Completing the form located here or contacting one of our Customer Care Representatives at 800-999-9789.
  • How can I obtain additional information on HIPAA?

    Dental Select is HIPAA compliant.
    For more information on HIPAA, please visit the following websites:

    US Department of Health & Human Services

    http://www.dhhs.gov/ocr/hipaa/

     

    Center for Medicaid Services
    www.cms.hhs.gov/hipaa/

  • When will my group receive renewal information?

    Renewal letters are sent to the group no later than 45 days prior to their renewal date.
    You will receive a copy of this letter approximately one week prior to the date the group’s copy is mailed.

  • What do I need to submit with a new group?

    The following information is required when submitting a new group application for benefits:

    • Group Application
    • Company check (for first month’s premium)
    • Employee enrollment forms
    • Proof of prior coverage (not applicable for Co-pay and Discount plans)
    • Summary of benefits from prior plan
    • Last month’s invoice from prior plan
    • Employee effective dates on prior plan
    • Census (Contributory plans & Voluntary Indemnity plans (Utah & Texas) or PPO plans (Utah only) with less than 5 enrolled)
    • Waiver enrollment forms (Contributory plans only)

     

    For your convenience, a New Group Submittal Checklist is available under Forms.

  • How do I request a quote?

    It’s easy to request a quote from Dental Select!
    Chose the most convenient method for you:

     

    1. Fax a completed Broker Quote Request form (available under “Forms” above) to (888) 673-5328 or (801) 290-5135.
    2. Email your request to quotes@dentalselect.com

     

    Please include your customization requirements including:

    • Waiting periods
    • Deductibles
    • R&C
    • Benefit structure
    • Maximums
    • Voluntary or Contributory
    • Commission desired (if not standard)
  • How soon can I expect to receive my quote?

    Dental Select has a 24 hour turnaround time on quotes for groups under 100 lives, and less than 72 hour turnaround time on larger group quotes.

     

    To assist us in providing you with an accurate and competitive quote, please submit the following information with your quote request, if applicable:

    • Current and renewal rates
    • Claims history/experience
    • Census information
    • Number of participating employees
    • Employer contribution
    • Copy of current summary of benefits
    • Bill from prior carrier
  • How do I become appointed to sell Dental Select products?

    Simply fill out the appointment forms located on this page along with a copy of your agent license. You may also complete this single form for multiple agents. For questions, or to request commission information for your state contact our Broker Support team at 800-999-9789 x401.

  • How do I request a new agent kit?

    Simply fill out the online form or call us at 1-800-999-9789.  A new agent kit, including appointment information and marketing materials will be promptly mailed to you.

  • How do I terminate a plan?

    You may terminate your group plan by submitting your request in writing to:

    Dental Select c/o Eligibility
    5373 S Green Street, 4th Floor
    Salt Lake City, Utah 84123

GET APPOINTED

Become an appointed broker with Dental Select. Complete the required agreement documents and have your license(s) prepared to attach. For assistance contact Christina at 800-999-9789 x7103. This form is applicable to all states.

SIGN IT HERE

BA AGREEMENT

Changes to HIPAA laws require revisions to all BA Agreements. You must sign a new BA Agreement in order to ensure uninterrupted access to PHI. This form is applicable to all states.

SIGN IT HERE

AGENT SUPPLIES

Complete the form below to order marketing materials. Or, click here to request a personalized link to offer our Individual products directly from your website.

REQUEST SUPPLIES

Call a Dental Select Customer Care Representative toll free at
1-800-999-9789 for personalized assistance.

Utah Avenue H Dental Plans

Avenue H is winding down operations on January 1, 2018. But don’t worry, Dental Select is here to help those who elected coverage with Dental Select through Avenue H’s website to avoid disruption and to simplify your transition.

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