Delta Dental - Dentists - NPI Information

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About Delta Dental

Oral Health and Wellness

Current Location: Delta Dental > Dentists > NPI Information

Delta Dental Request for Proposal (RFP) Assistant

The Member Company you selected is: DELTA DENTAL OF NEW JERSEY

Additional Requirements:

Delta Dental of New Jersey only provides coverage to groups of 15 or more employees without prior dental insurance or 10 or more employees with prior dental insurance.

Marketing and Sales Contact:

Diane Baquero

Phone:

800-624-2633

FAX:

973-285-4139

E-mail:

dbaquero@deltadentalnj.com

Mailing Address:

P.O. Box 222

Parsippany, NJ 07054

Web Site:

www.deltadentalnj.com

Required fields are indicated with an asterisk (*).

1. Tell us a little about who you are!

	*First Name:
	*Last Name:
	Company:
	Title:
	Street Address:
	Address 2:
	City:
	State:
	Zip Code:
	Country:
	Phone:	- -
	Fax:	- -
	*E-mail:

2. Please choose:

Are you a:

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:

3. 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 5.

4. If you answered YES, then:

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

	Traditional indemnity
	Preferred Provider
	Dental HMO

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 needed
	Company policy to re-bid
	Better cost/value
	Larger network needed
	Other

How soon will you need a formal bid response?

Date:

5. If you answered NO, then:

What type of dental benefits plan are you interested in?

	Traditional indemnity
	Preferred Provider
	Dental HMO

How soon would you like the program in place?

Date:

How soon will you need a formal bid response?

Date:

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

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