Companion Life Calculator
Please complete the form below to create a quote.
Agent/Agency Information
Name:
Email:
Phone Number:
Group Information
Employer Name:
State:
Please choose...
Arizona
Idaho
Illinois
Minnesota
North Dakota
Nebraska
Texas
Utah
Wisconsin
Zip Code:
Industry Code:
Please choose...
Schools, Government, Legal/Law Firms (+20%)
All Other Industries
Dental Plan Design
Employee Enrollment:
2-4 Employees Enrolled
5-100 Employees Enrolled
Check here if you will have 10+ eligible employees
Participation:
75% or More
Voluntary, Less Than 75%
Choose a Deductible:
$100 Lifetime
$50/$150 Contract Year or Calendar Year (+5%)
$25/$75 Contract Year or Calendar Year (+8%)
$0 Contract Year or Calendar Year (+26%)
Annual Maximum:
$1,000 Contract Year or Calendar Year
$1,500 Contract Year or Calendar Year (+10%)
$2,000 Contract Year or Calendar Year (+15%)
$2,500 Contract Year or Calendar Year (+20%)
$3,000 Contract Year or Calendar Year (+25%)
$5,000 Contract Year or Calendar Year (+50%)
Additional Options
Move Endodontic/Periodontal / Oral Surgery to Basic (+15%)
Remove Waiting Periods (+7%)
50% or more related by blood or marriage (+10%)
2 year rate guarantee (+5%, free in ND)
Add Orthodontics (Adult and Child) (+flat amount)
Add Vision (+flat amount, not available in ND)
Add Accident (+flat amount, MN only, groups 5+)
Ortho Options
Ortho Lifetime Maximum:
Please choose...
$1,000 Lifetime
$1,500 Lifetime
Vision Plan Options
Participation:
75% or More
Voluntary, Less Than 75%
Plan Type:
Please choose...
Comprehensive Plan
Materials Only
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