TDA (Total Dental Administrators)

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To inquire about TDA, please contact our staff.

Benefits they can offer: 

  • Dental (2+)
  • 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:

 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.

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