BEAM CUSTOM DENTAL QUOTE REQUEST

CONFIDENTIALITY NOTICE:

All materials, rates, processes are subject to your Non-Disclosure agreement with Voluntary Insurance Partners, LLC. By submitting this form you are acknowledging this statement.
BEAM CUSTOM Dental/Vision quote request

This form is exclusively for BEAM DENTAL Partners to initiate a case in preparation for your presentation. The provided information will also be utilized to create an electronic data cache for seamless enrollment (referred to as ExpressEnroll). Moreover, this can serve as a valuable closing tool during your presentation. Once the process is completed, you will receive the link to your Enrollment Form for unrestricted use, along with your proposal.
YOUR Name*

First NameLast Name
Executive Partner Email Address*
example@example.com
Your email address:*
jdoe@voluntarypartners.com
Your Sales Executive will be TESSA KELLY - tessa.kelly@beambenefits.com - 440-213-9592
Company/Group Name (Prospect)*
Company Zip Code
# of Eligible Employees
Nature of their business*
Is this case*

VoluntaryContributory
What percentage of Dental is the employer contributing?*
What percentage of Vision is the employer contributing?*
Effective Date for the plans (They bill a month in advance)*

MonthDayYear
Date
If you have a company census (names/DOB's/zip codes) It can sometimes help the quote. If one is available... please upload it here

Browse Files

Cancelof
IS there anything unique (like a takeover) where you need a different benefit amount or features than our standard EPIC offer?

YesNo... Our offer is super competitive and ROCKS!
Would you like to receive a quote for $25k in EMPLOYER PAID GROUP life that includes EAP, AD&D, and travel insurance through Nationwide? (Average cost is $5.50/PEPM for $25,000)*

YesNo
If needed...please explain What you would like differently in the offer than what is below than the offer below:
BEAM UNDERWRITERS: PLEASE QUOTE THE FOLLOWING STANDARD DESIGN and email the quote to newcase@voluntarypartners.com

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DENTAL:

Voluntary MAC 100/80/50/0 in and out of network.

50/150 deductible.

$2000 max.

endo/perio in BASIC.

sealants/space main in prev.

imp/alt; no wp’s

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VISION:

Voluntary - VSP 3

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2 year rate guarantee

Thank you!
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CONFIDENTIALITY NOTICE:

BEAM CUSTOM Dental/Vision quote request