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:
2015 Total Care Group App & Cover
Life, LTD, STD Group Application
Employee Forms- New Hire, Change of address, change of name, dependent add or removal, and employee terminations.
Companion Life Group Health Statement
Total Care Booklet – Executive Plus
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 firstname.lastname@example.org for processing.
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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