For an inexpensive group dental plan, we have found the first choice to be Horizons Dental Design. This is designed for groups of 2 - 99 employees. Everything need to explain the plan, generate rates, and enroll your group is in the links below.

For a brochure for Horizons Dental Design
For Rates good until June 30, 2003
For Rates good after June 30, 2003
For a Group Application
For Employee Applications
For an Administrative Guide

For groups of 25 or more, or if your company needs particular benefit levels or structure, complete the form below.

Date		Possible Effective Date
Company name		Phone #
Contact name		Fax #
Address City State, Zip County		Type of Business
Contact Email		Website

Information that will determine if the group qualifies for either Employer Sponsored or Voluntary programs.

Total number of full time employees:

Total number to enroll:

Employer will contribute

% of employee

Employer will contribute

% of dependents

Current Carrier

Renewal Month

Current Rates:

E	E/C	E/S	E/F

Please choose desired benefit structure.

Services	Options First Variable is most common	Choice
PREVENTIVE SERVICES: Exam, x-rays, teeth cleanings	100% or 80%
BASIC SERVICES: Fillings, oral surgery, root canals	80% or 90%
MAJOR SERVICES Crowns, bridges, dentures	50% or 60%
ORTHODONTIC SERVICES Straightening of teeth	50% or No Coverage
DEDUCTIBLE AMOUNT	$50, $25, or $ 100
DEDUCTIBLE WAIVED FOR PREVENTATIVE SERVICES?	Yes or No
GENERAL DENTISTRY ANNUAL MAXIMUM BENEFIT:	$1000 OR $1500
ORTHODONTIC LIFETIME MAXIMUM BENEFIT:	$1000 OR $1500

Information about your employees.

If you have additional employees, fax them to (704-588-7971) using this same format.

Check here if you wish to have an agent contact you prior to quotes being generated.

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