TDA (Total Dental Administrators)

To inquire about TDA, please contact our staff.

Benefits they can offer:

• Dental (2+)
  • Discount Vision and Hearing Included
• Vision (10+) Partnered with Opticare
• Life (2+) Administered by
• AD&D (2+)
• LTD- Long Term Disability (5+)
• STD- Short Term Disability (5+)

All of these will need to be quoted by TDA. Please contact our staff for additional information.

Quote Request Forms:

For quote and rate information for TDA please contact our staff. Please note it can take 7 to 10 business days to receive quotes back.

Group Ancillary Quote Request Form

New Business Submission forms:

Employer Forms-

PPO Group Enrollment

Group Check Off List (v1)

2015 Total Care Group App & Cover

ACH Deductions – DHMO UT

Life, LTD, STD Group Application

EFT Enrollment

Employee Forms- New Hire, Change of address, change of name, dependent add or removal, and employee terminations.

Enrollment Form 3 Tier

Companion employee app

Companion Life Group Health Statement

Life enrollment form

Marketing/Flyers:

The TDA Difference

Shelf Rates 2015

Total Care Booklet – Executive Plus

Total Care Booklet – Signature Plus

Provider Search:

In state members: https://www.tdadental.com/providers/find_provider.php

Out of state members: www.dentemax.com

AOR (Agent of Record) Letter:

Below is a generic AOR to complete on letter head and fill in the parenthesis (i.e. [COMPANY NAME]= ABC Company). If you have any questions, please contact our staff. Please submit the completed AOR to ella@stonehill.net for processing.

SHN AOR

The forms posted on this page are for 2017. If you are interested in any forms for previous years or any pre-ACA plan forms please contact our staff.