VBA Calculator
Please complete the form below to create a quote.
Agent/Agency Information
Name:
Email:
Phone Number:
Group Information
Employer Name:
State:
Please choose...
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
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New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Wisconsin
West Virginia
Wyoming
Zip Code:
Industry Code:
Please choose...
Schools, Government, Legal/Law Firms (+20%)
Schools/Educational (+20%)
City, County, State or Federal Governmental Agencies (+20%)
Interior Decorating or Design (+20%)
Religious, Charitable, Political, Membership or Fundraising Organization Administrative Staffs (+20%)
Insurance Agents, Brokers, Carriers or Title Insurance Offices (+20%)
Banks, Law Firms or Law Offices (+20%)
Jewelry stores (+20%)
Real Estate Offices (+20%)
All Other Industries
Dental Plan Design
Plan Base:
Ameritas Enhanced
Ameritas Basic
Dual Choice
Employee Enrollment:
3-4 Lives
5-9 Lives
10-149 Lives
12 Months Comparable Prior Group Dental Coverage:
Please choose...
Yes Prior Coverage
No Prior Coverage (+25%)
Additional Options
$2,000 Lifetime Child & Adult Orthodontia (+8%)
Vision Plan Design
(VSP not available in MA)
Choose a Network:
Please choose...
Spirit EyeMed
Spirit VSP
Spirit EyeMed Plan Options
Plan Base:
Please choose...
Plan A - 12/12/12 $0/$0
Plan B - 12/24/24 $0/$0
Plan C - 12/12/12 $10/$10
Plan D - 12/24/24 $10/$10
Plan E - 12/12/12 $10/$20
Plan F - 12/24/24 $10/$20
Plan G - Materials Only 12/24
Plan H - Materials Only 12/12
Participation:
Please choose...
75% or More
Voluntary, less than 75% (+5%)
Spirit VSP Plan Options
Plan Base:
Please choose...
Plan 1 - 12/12/24 $10/$25
Plan 2 - 12/12/24 $10/$10
Plan 3 - 12/12/12 $10/$25
Plan 4 - 12/12/12 $10/$10
Tier:
Please choose...
Tier 3 -- Employee, Employee + 1, Employee + Family
Tier 4 -- Employee, Employee + 1, Employee + Child(ren), Employee + Family
Submit