BEAM SOLD CASE NOTIFICATION

Group Name
Effective Date of the Dental plan

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Number of eligible employees
Nature of their Business
Group Zip Code

Street Address

Street Address Line 2

City

Zip Code
Agent Name

First NameLast Name
Agent Email
example@example.com
Select ALL Sold Products that apply to this case:
Would you like to have your VIP Enrollment Director complete the data input, submissions, deduction reports and complete your Transmittals? They will send the deduction report directly to you once the transmittal is complete. This makes life MUCH easier.
Is this case a custom quoted case or Standard Shelf rates?
Who is/are your Executive Partner(s) to receive this notice.
Hey there!

I have sold this case.

Please send me the IMPLEMENTATION EMAIL to complete.

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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

Thank you!
Should be Empty: