DentaQuest Benefit Solutions

Need a quote or proposal for one or more of our plans?

We would be happy to provide your organization with a customized proposal or price quote. Simply submit the form below, or you can e-mail us at sales@dentaquest.com. Please provide us with a census, claims history, and any other relevant information about your group. We promise to respond within one business day of your submission.

Group Information:

Group Name:

Address (Headquarters):	City:
State:	Zip Code:
Telephone Number: () -Second partThird part	Business type with SIC or detailed description:
Number of Employees:	Effective Date:

Which products would you like to receive a proposal for? (Please check all boxes that apply.)

Dental Plans:

Indemnity Dental Benefits:	Voluntary PPO Dental Plan:
Employer Sponsored PPO Dental Plans:	Self-Funded Dental Plans:

Vision Plans:

Standard Plans:

Premier Plan:

Diamond Plan:

How many employees are eligible for benefits?:

Does the group currently offer dental benefits?:

What is the name of the current carrier?:

Will the employer contribute to the employee's premium?:

If yes, what percentage?:

Does the group have eligible employees who live outside of Maryland, Virginia, and Washington, D.C.?:

Please send a census and claim history to: sales@dentaquest.com