Dental Select

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Our dental plans offer customizable plan designs, affordable prices and local customer service. With discount, co-pay and co-insurance plans available, each plan includes access to one of the largest dental networks in the state of Utah.


Benefits they can offer:

  • Discount Vision attached with Dental
  • Vision
  • AD&D


Quote Request Forms:

Dental, Voluntary Vision, and Contributory Vision Street Rates are offered for most industries. If you have specific benefit needs, they need to be quoted by Dental Select. Please contact our staff for additional information.

For additional quote and rate information for Dental Select, 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-

New Group Checklist Fully Insured

Group App Fillable

Employee Forms-

All Enrollment Form Fillable

Change of address, change of name, dependent add or removal, and employee terminations.

Employee Change Form


Provider Search:

Please click the below link for an up-to-date provider search.

Marketing/Sales Material:

About Us

ID App Flyer

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 for processing.

Dental Select AOR blank


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.


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