Yearly Enrollment Fee

  • $55 yearly enrollment fee per individual

  • $90 yearly enrollment for two people

  • $125 yearly enrollment for three people

  • Group Enrollment - $155 covers up to six people

Save Money On Your Yearly Enrollment...To save money on your yearly dental enrollment fees, sign up additional people with the first enrollment.  For instance, up to six people can enroll for $155.   They don't have to live at the same address, nor do they have to be related. That brings down the yearly enrollment fee to a little more than $26 per person (saving nearly 50%).  Group enrollment packages can include family, friends, co-workers, neighbors or anyone without dental insurance who may need dental coverage.  

Online Dental Plan Enrollment Form

Primary Plan Member's Name:
Date:  Telephone #:
Street Address:
City, State, Zip:

List Names Of Additional Family
Members On Dental Plan
1.
2.
3.
4.
5.
 

Email: