Companion Life Calculator | Direct Benefits Inc.

Agent/Agency Information

Name:

Email:

Phone Number:

Group Information

Employer Name:

State:

Zip Code:

Industry Code:

Effective Date:

Dental Plan Design

Employee Enrollment:

Check here if you will have 10+ eligible employees

Participation:

Choose a Deductible:

Annual Maximum:

Move Endodontic/Periodontal / Oral Surgery to Basic (+15%)

Remove Class III Waiting Period (+7%)

50% or more related by blood or marriage (+10%)

2 year rate guarantee (+5%, 0% in ND)

Add Orthodontics (Adult and Child) (+flat amount)

Add Vision (+flat amount, not available in MT, or WA)

Ortho Options

Ortho Lifetime Maximum:

Vision Plan Options

Please choose one of the below vision providers.

Vision Provider: