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


The TDA Difference

Shelf Rates 2015

Total Care Booklet – Executive Plus

Total Care Booklet – Signature Plus

Provider Search:

Out of state members:

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.


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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