Individual Dental Insurance

Individual Dental Insurance is available to individuals and families that are not covered on group dental insurance. For people without dental insurance, cost often stands in the way of getting the care they need to maintain the health of their teeth and gums. Even for routine preventive care, a trip to the dentist's office could mean a substantial amount of money out of your pocket.

A freedom-of-choice plan allows you to see any dentist you wish. However, this plan does impose 6- to 12-month waiting periods for some services. This is not the best plan for an individual who needs comprehensive coverage within the first 12 months. However, if dental coverage is desired for a long period of time, and there is no rush to receive the major benefits, this plan may work for you.

Individual Dental Insurance Quote Request

Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

* Required fields.

Personal Information
Full Name: *
Address:
City:
State:	Zip:
Phone: *
Best Time To Call:	AM PM
E-mail Address: *

Current Individual Dental Insurance Information
Carrier / Company Name: (not agency)
Policy Expiration Date:	Premium Amt: $
Years Insured:
Please give a brief description of your current health plan, if applicable:

Family Information
Please list all family members you wish to cover:
Name	Date of Birth	Sex
		Male Female
		Male Female
		Male Female
		Male Female
		Male Female
		Male Female
		Male Female
If you were not able to list all family members you wish to cover in the spaces above, please use the Additional Comments section below or indicate that you will fax or e-mail an additional listing.

Additional Comments or Questions

Enter Security Code:

Please click the "Submit Quote Request" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.

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