Companion Life Calculator
Please complete the form below to create a quote.
For Effective Dates of 7/1/2024 - 12/31/2025
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Agent/Agency Information
Name:
Email:
Phone Number:
Group Information
Employer Name:
State:
Please choose...
Arizona
Idaho
Illinois
Minnesota
North Dakota
Nebraska
Texas
Utah
Washington
Wisconsin
Zip Code:
Industry Code:
Please choose...
Schools, Government, Legal/Law Firms (+18%)
All Other Industries (+0%)
Effective Date:
Dental Plan Design
Employee Enrollment:
2-4 Employees Enrolled (+0%)
5-200 Employees Enrolled (+0%)
50-200 Employees Enrolled (+0%)
Check here if you will have 10+ eligible employees
Participation:
75% or More (+0%)
Voluntary, Less Than 75% (+5%)
Choose a Deductible:
$100 Lifetime (+0%)
$50/$150 Contract Year or Calendar Year (+5%)
$25/$75 Contract Year or Calendar Year (+8%)
$0 Contract Year or Calendar Year (+26%)
Annual Maximum:
$1,000 Contract Year or Calendar Year (+0%)
$1,500 Contract Year or Calendar Year (+10%)
$2,000 Contract Year or Calendar Year (+15%)
$2,500 Contract Year or Calendar Year (+20%)
$3,000 Contract Year or Calendar Year (+25%)
$5,000 Contract Year or Calendar Year (+50%)
Additional Options
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:
Please choose...
$1,000 Lifetime (+flat amount)
$1,500 Lifetime (+flat amount)
Vision Plan Options
Participation:
75% or More (+0%)
Voluntary, Less Than 75% (+5%)
Plan Type:
Please choose...
Comprehensive Plan (+0%)
Materials Only (+0%)
Vision Plan Options
Participation:
Voluntary
Non-Voluntary
Plan Type:
Annual Allowance of $100
Annual Allowance of $120
Annual Allowance of $150
Annual Allowance of $175
Annual Allowance of $200
Submit
