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RFP Form

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I'm An Employer benefits professional Insurance broker Other

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Company

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Where is the company's home office?

Is the company address listed where the insurance buying decisions are made? Yes No

If no, where are decisions made?

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What’s the company’s SIC code?

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Does the company currently offer dental insurance to its employees? Yes No

If Yes: Is this a voluntary program, or does the company pay all/part of the benefit? Voluntary Employer pays all Employer & employee contribution

If Yes: When does the contract with the current carrier expire?

Why are you looking for a new dental insurance company? Dissatisfied with service More plan options needed Company policy to rebid Better cost/value Larger network needed Other

How soon do you need a benefits proposal from us?

When would you like your dental plan to begin?

Is there anything else you would like to tell us about the company?

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Delta Dental of Kansas is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.