Betadental.com Colorado Dental Plans, Your #1 Choice

Betadental.com Colorado Dental Plans, Your #1 Choice

Marketing Representative or Current Account Supply Request Form

If you are a Marketing Representative or have a current account please use the following form to request copies of our current enrollment forms, brochures, agreements and provider directories.

Information Request Form

I would like the following items. Check at least one:
Mailed	E-mailed	Faxed
I need these items by the following date/time:

Administrative Forms

Beta Network Plans

Size

Print or Download

Order Quantity

BHA Change of Status Form

20 KB

Agent Material

Size

Print or Download

Order Quantity

BHA Companion Life Agent Agreement

172 KB

BHA Securian Colorado Agent Agreement

1174 MB

BHA Securian Non-Colorado Agent Agreement

585 KB

Alpha Individual Plan Material (AI)

Non-Western Slope (NWS)

English

Size

Print or Download

Order Quantity

AI NWS Long Version Enrollment Kit-English

238 KB

Spanish

Size

Print or Download

Order Quantity

AI NWS Long Version Enrollment Kit-Spanish

234 KB

Western Slope (WS)

English

Size

Print or Download

Order Quantity

AI WS Long Version Enrollment Packet-English

334 KB

Spanish

Size

Print or Download

Order Quantity

AI WS Long Version Enrollment Kit Spanish

234 KB

Alpha Only Group Material (AG)

Non-Western Slope (NWS)

Employer

Size

Print or Download

Order Quantity

AG NWS Network Plans Group Agreement

47 KB

English

Size

Print or Download

Order Quantity

AG NWS Employee Enrollment Packet-English

174 KB

Spanish

Size

Print or Download

Order Quantity

AG NWS Employee Enrollment Packet-Spanish

269 KB

Western Slope (WS)

Employer

Size

Print or Download

Order Quantity

AG WS Network Plans Group Agreement

27 KB

English

Size

Print or Download

Order Quantity

AG WS Employee Enrollment Packet-English

174 KB

Spanish

Size

Print or Download

Order Quantity

AG WS Employee Enrollment Packet Spanish

288 KB

Beta Health Fee Schedules

All Products Fee Schedule

Size

Print or Download

Order Quantity

New June 2006 Fee Schedule-All Products

27 KB

Alpha Plan A Fee Schedule

Size

Print or Download

Order Quantity

New June 2006 Plan A Fee Schedule

24 KB

Careington POS Fee Schedules

Enrollment Specific Choice POS Fee Schedules 0103

Size

Print or Download

Order Quantity

CI-1 Care POS

89 KB

CI-10 Care POS

89 KB

CI-11 Care POS

89 KB

CI-12 Care POS

89 KB

CI-13 Care POS

89 KB

CI-2 Care POS

89 KB

CI-3 Care POS

89 KB

CI-4 Care POS

89 KB

CI-5 Care POS

89 KB

CI-6 Care POS

89 KB

CI-7 Care POS

89 KB

CI-8 Care POS

88 KB

CI-9 Care POS

89 KB

National Choice POS State Fee Schedule Listing

33 KB

BHA Group Rate Sheets - Enrollment Meetings

Alpha Group Dental Plan (AG)

Non-Western Slope (NWS)

English

Size

Print or Download

Order Quantity

AG NWS Rate Sheet English

9 KB

Spanish

Size

Print or Download

Order Quantity

AG NWS Rate Sheet Spanish

8 KB

Western Slope (WS)

English

Size

Print or Download

Order Quantity

AG WS Plan Rate Sheet English

9 KB

Spanish

Size

Print or Download

Order Quantity

AG WS Rate Sheet Spanish

8 KB

Select Choice Dental Plan (SC)

Non-Western Slope (NWS)

English

Size

Print or Download

Order Quantity

SC NWS Rate Sheet English

9 KB

Spanish

Size

Print or Download

Order Quantity

SC NWS Rate Sheet Spanish

8 KB

Western Slope (WS)

English

Size

Print or Download

Order Quantity

SC WS Rate Sheet English

9 KB

Spanish

Size

Print or Download

Order Quantity

SC WS Plan Rate Sheet Spanish

8 KB

Triple Choice Dental Plan (TC)

Non-Western Slope (NWS)

English

Size

Print or Download

Order Quantity

TC NWS Rate Sheet 1st qtr 2006 English

18 KB

TC NWS Rate Sheet 2nd qtr. 2006 English

26 KB

TC NWS Rate Sheet 4th Qtr. 2006 English

26 KB

TC NWS Rate Sheet July and August 2006 English

29 KB

TC NWS Rate Sheet September 2006 English

26 KB

Spanish

Size

Print or Download

Order Quantity

TC NWS Rate Sheet 1st qtr 2006 Spanish

18 KB

TC NWS Rate Sheet 2nd qtr 2006 Spanish

18 KB

TC NWS Rate Sheet 3rd qtr 2006 Spanish

18 KB

TC NWS Rate Sheet 4th qtr 2006 Spanish

18 KB

Western Slope (WS)

English

Size

Print or Download

Order Quantity

TC WS Rate Sheet 1st qtr 2006 English

18 KB

TC WS Rate Sheet 2nd qtr 2006 English

18 KB

TC WS Rate Sheet 4th Qtr. 2006-English

26 KB

TC WS Rate Sheet July and August 2006-English

26 KB

TC WS Rate Sheet September 2006-English

26 KB

Spanish

Size

Print or Download

Order Quantity

TC WS Rate Sheet 1st qtr 2006 Spanish

18 KB

TC WS Rate Sheet 2nd qtr 2006 Spanish

18 KB

TC WS Rate Sheet 3rd qtr 2006 Spanish

18 KB

TC WS Rate Sheet 4th qtr 2006 Spanish

18 KB

Business Groups of One Material (BGO)

Non Western Slope (NWS)

English

Size

Print or Download

Order Quantity

BGO NWS Enrollment Packet

244 KB

Western Slope (WS)

English

Size

Print or Download

Order Quantity

BGO WS Enrollment Packet

245 KB

Discount Services

Size

Print or Download

Order Quantity

Color Discount Flier w-ID Card

180 KB

Indemnity and PPO Plans

Companion Life

Companion Life Forms

Size

Print or Download

Order Quantity

Covered Services Sheet

51 KB

Employee Enrollment Form

40 KB

Employer Agreement

35 KB

Securian Dental

Colorado Groups

Size

Print or Download

Order Quantity

Securian Colorado Employee Enrollment Packet

456 KB

Securian Colorado Employer Agreement Kit

651 KB

Securian Colorado Employer Paid And Voluntary Group Participation and Underwriting Guidelines

51 KB

Securian Colorado Employer Paid Group Participation and Underwriting Guidelines

43 KB

Securian Colorado Provider Directory

72 KB

Securian TC Proposal

488 KB

General Forms

Size

Print or Download

Order Quantity

Who is Beta Health

27 KB

Why Securian Dental

41 KB

Non-Colorado Groups

Size

Print or Download

Order Quantity

Securian Non-Colorado Employee Enrollment Form

95 KB

Securian Non-Colorado Employer Agreement

155 KB

Securian Non-Colorado Employer Paid Group Participation and Underwriting Guidelines

43 KB

Securian Non-Colorado Voluntary Group Participation and Underwriting Guidelines

43 KB

Provider Directories

Beta Health Directories

English

Size

Print or Download

Order Quantity

All Products Provider Directory-English

55 KB

Alpha Provider Directory-English

48 KB

Participating Specialist Directory

33 KB

Spanish

Size

Print or Download

Order Quantity

All Products Provider Directory-Spanish

37 KB

Alpha Provider Directory-Spanish

29 KB

Securian Directories

Securian Provider Directories

Size

Print or Download

Order Quantity

Securian Colorado Provider Directory

72 KB

Select Choice Material-Non Western Slope Only (SC)

SC Network Plans Group Agreement

54 KB

Employee Enrollment Packets

English

Size

Print or Download

Order Quantity

SC Employee Enrollment Packet-English

245 KB

Spanish

Size

Print or Download

Order Quantity

SC Employee Enrollment Packet-Spanish

285 KB

Triple Choice Material (TC)

Employee Enrollment Packets

English

Size

Print or Download

Order Quantity

TC Employee Enrollment Packet-English

3389 MB

Spanish

Size

Print or Download

Order Quantity

TC Employee Enrollment Packet-Spanish

380 KB

Employer Material

Employer Agreement Kit

Size

Print or Download

Order Quantity

TC BHA Employer Agreement

99 KB

TC Companion Life Employer Agreement

35 KB

Employer Proposal

Size

Print or Download

Order Quantity

TC Employer Proposal with Rate Sheets

480 KB

Vision Plan Material

Vision Plan Forms

Size

Print or Download

Order Quantity

Vision Plan Enrollment Brochure

52 KB

Vision Plan Group Agreement

29 KB

Vision Provider Directory-Statewide-10106

22 KB

Send the above items to(*required):
Name:	*
Title:
Company or Agency Name (if applicable):
Address:	*
Address 2:
City:	*
State:	*
Zip:	*
Phone Number:	*
Fax Number:
E-mail Address:	*
Stay informed about changes at Beta Health Association with our quarterly newsletters and email communications. (We will not share your email address) More info...	Join
Did you find what you need? If not, please use the comments field below or our web site feedback form to let us know how we can improve our web site to meet your needs.	Yes No
Comments:

Any information submitted using this form will not be shared with any third parties.

¹These items can only be mailed or faxed and not e-mailed.

- Top -

Thank you for visiting our website. If you have experienced any problems,
please feel free to contact us using our site feedback form or the numbers below.

Beta Health Association, Inc., 9725 E. Hampden Ave., Suite 400, Denver, CO 80231
303-744-3007 | 800-807-0706

Home - Individual Plan - Group Plan - Providers - Help and Info - Contact - About Us

Site Map - Privacy Policy

Copyright © Beta Health Association, Inc., 2008. All Rights Reserved.

Valid XHTML | Valid CSS

Please report any problems with this site to
Web Design and Development by ON2K