enrollment kit - california dental network (dental)
X
0
Forms Selected
Clear Selection
Form Name
Effective Date
Current As Of
"Current As Of" signifies the latest date on which a Word & Brown
Team Member confirmed that the Forms/Document available for download represents the most up-to-date and recently
revised version accessible.
Our goal is to process your new group enrollment easily and efficiently in order to provide you and your client with a quick approval. The following list outlines California Dental Network’s case submission requirements
- Application for Group Coverage - Employer Application (DHMO).
- Census Enrollment Sheet.
- Employee Enrollment Forms – submit one enrollment form per enrollee.
- Advantage Plan 75 Employee Enrollment Application and Brochure
- Advantage Plan 75 Employee Enrollment Application and Brochure (Espanol)
- Advantage Plan 100 Employee Enrollment Application and Brochure
- Advantage Plan 100 Employee Enrollment Application and Brochure (Espanol)
- Advantage Plan 150 Employee Enrollment Application and Brochure
- Advantage Plan 150 Employee Enrollment Application and Brochure (Espanol)
- Advantage Plan 200 Employee Enrollment Application and Brochure
- Advantage Plan 200 Employee Enrollment Application and Brochure (Espanol)
- Advantage Plan 250 Employee Enrollment Application and Brochure
- Advantage Plan 250 Employee Enrollment Application and Brochure (Espanol)
- First month’s premium check made payable to “California Dental Network”.
- Prior Carrier Invoice and Prior Carrier Benefit Summary, if applicable.
- Copy of quote or copy of rates used to sell case.
- Broker Licensing: Agent Contract and copy of license (if applicable).
After approval, prior carrier termination letter must be submitted by the employer or broker.
For other useful or older documents, please refer to the Forms database.