File |
Description |
SmileSaver/Safeguard
Agent's Service Agreement
Part 1 |
California Producer Contract between SmileSaver and the agent |
SmileSaver/Safeguard
Agent's Service Agreement
Part 2 |
Commission Agreement between SmileSaver and the agent |
|
W9-Form |
This is a link to the IRS W9-Form |
|
Enrollment form for new groups
|
SmileSaver
ChoicePlus Employer Application |
Application form for new ChoicePlus groups |
File |
Description |
SmileSaver
Group Plan Comparison |
Comparison of Plan 1000/1000S, 2000/2000S, 3000/3000S, SM600 North & South |
SmileSaver
Group Master Application |
Enrollment form for new groups |
SmileSaver
Group Member Enrollment Form |
Enrollment form for group members |
|
SmileSaver
Benefit Change Form |
To change enrollment or dependent information |
Forms |
Description |
SM400 and SM600 Comparison |
Individual Plan Comparisons |
|
400N Enrollment Form |
Enrollment Form for Individual Plans SM400 Northern CA |
|
400S Enrollment Form |
Enrollment Form for Individual Plans SM400 Southern CA |
|
600N Enrollment Form |
Enrollment Form for Individual Plans SM600 Norther CA |
|
600S Enrollment Form |
Enrollment Form for Individual Plans 600 Southern CA |
Forms |
Description |
Sample Group Administrator Contract |
Sample Group Administrator Contract |
|
Group Dental Plan EOC |
Explanation of Coverage for all SmileSaver Group Dental Plans |
Individual Dental Plan 400N |
Individual Dental Plan SM400 Northern CA Enrollment Kit |
Individual Dental Plan 400S |
Individual Dental Plan SM400 Southern CA ENrollment Kit |
Individual Dental Plan 600N |
Individual Dental Plan SM600 Northern CA Enrollment Kit |
Individual Dental Plan 600S |
Individual Dental Plan SM600 Southern CA Enrollment Kit |
Forms |
Description |
Plan 1000 |
Plan 1000 Description of Benefits & Co-payments |
Plan 2000 |
Plan 2000 Description of Benefits & Co-payments |
Plan 3000 |
Plan 3000 Description of Benefits & Co-payments |
Plan 1000S |
Plan 1000S Description of Benefits & Co-payments |
Plan 2000S |
Plan 2000S Description of Benefits & Co-payments |
Plan 3000S |
Plan 3000S Description of Benefits & Co-payments |
Plan SM400 Southern California |
Plan SM400 Southern California Enrollment Kit |
Plan SM400 Northern California |
Plan SM400 Northern California Enrollment Kit |
Plan SM600 Southern California |
Plan SM600 Southern California Enrollment Kit |
Plan SM600 Northern California |
Plan SM600 Northern California Enrollment Kit |
|
Group Dental Plan EOC |
Explanation of Coverage for all SmileSaver Group Dental Plans |
