Delta Dental Request for Proposal (RFP) Helper 

 

 

 

 

The plan you selected is:
   DELTA DENTAL OF WYOMING
Marketing and Sales Contact:
   Mr. Kerry Hall
Phone:
   800-735-3379
FAX:
   307/632-7309
E-mail:
   khall@vcn.com
Mailing Address:
   P.O. Box 29
   Cheyenne, WY  82003-0029

 

All required fields are denoted with a Required symbol.

2

Tell us a little about who you are!

 

 

 

 

First Name:

Required

Last Name:

Required

Company:

Title:

Street Address:

Address 2:

City:

State:

Zip Code:

Country:

Phone:

-  - 

Fax:

-  - 

E-mail:

Required

 

 

 

3

Please choose:

 

 

 

Are you a: Required

 

Employer Benefits Professional

Dental Health Benefit Consultant

Insurance Broker

If you are a Dental Health Benefit Consultant or an Insurance Broker, please answer the following questions:

 

Company Representing:

Client Company:

Client Address:

Address 2:

City:

State:

Zip Code:

Country:

 

 

 

 4 

Tell us a little about the company/client:

 

 

 

Where is the company's home office?

 

City:

State:

Is this where the benefit buying decision is made?

 

Yes  No

If "No", where is the decision made?

City:

State:

What is the company's SIC Code?

 

SIC Code:

What is your estimate of the total employees and family members?

 

Employees:

Add'l Family Members:

Does the company currently offer a dental benefit to its employees?

 

Yes  No


If you answered "No" above, please skip to section 6.

 

 

 

5

If you answered YES, then:

 

 

 

Please indicate the type of plan currently offered:<:
(check all that apply)

 

Traditional indemnity

 

 

Is this a voluntary program or does the company pay all or part of the benefit?

 

Voluntary

Employer pays all

Employer/Employee contribution

When does the contract with the current carrier expire?

 

Date:

Who is the current carrier?

 

Name:

Why are you looking for a new dental benefits carrier?
(check all that apply)

 

Dissatisfied with service

More plan options neeeded

Company policy to re-bid

Better cost/value

Larger network needed

Other

How soon will you need a formal bid response?

 

Date:


Please skip to section 7.

 

 

 

6

If you answered NO, then:

 

 

 

How soon would you like the program in place?

 

 

Date:

 

How soon will you need a formal bid response?

 

 

Date:

 

 

 

 

7

Is there anything else you would like to tell us about the company?