Dental Plans in Colorado Betadental.com Colorado Dental Plans, Your #1 Choice
Betadental.com Colorado Dental Plans, Your #1 Choice Dental Plans in Colorado
Dental Plans in Colorado
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Dental Plans in Colorado

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
 
Help?
Beta Network Plans
SizePrint or DownloadOrder Quantity
 BHA Change of Status Form
20 KB
 
Help?
Agent Material
SizePrint or DownloadOrder 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)
 
Help?
English
SizePrint or DownloadOrder Quantity
 AI NWS Long Version Enrollment Kit-English
238 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 AI NWS Long Version Enrollment Kit-Spanish
234 KB
 
Western Slope (WS)
 
Help?
English
SizePrint or DownloadOrder Quantity
 AI WS Long Version Enrollment Packet-English
334 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 AI WS Long Version Enrollment Kit Spanish
234 KB
 
Alpha Only Group Material (AG)
 
Non-Western Slope (NWS)
 
Help?
Employer
SizePrint or DownloadOrder Quantity
 AG NWS Network Plans Group Agreement
47 KB
 
Help?
English
SizePrint or DownloadOrder Quantity
 AG NWS Employee Enrollment Packet-English
174 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 AG NWS Employee Enrollment Packet-Spanish
269 KB
 
Western Slope (WS)
 
Help?
Employer
SizePrint or DownloadOrder Quantity
 AG WS Network Plans Group Agreement
27 KB
 
Help?
English
SizePrint or DownloadOrder Quantity
 AG WS Employee Enrollment Packet-English
174 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 AG WS Employee Enrollment Packet Spanish
288 KB
 
Beta Health Fee Schedules
 
Help?
All Products Fee Schedule
SizePrint or DownloadOrder Quantity
 New June 2006 Fee Schedule-All Products
27 KB
 
Help?
Alpha Plan A Fee Schedule
SizePrint or DownloadOrder Quantity
 New June 2006 Plan A Fee Schedule
24 KB
 
Careington POS Fee Schedules
 
Help?
Enrollment Specific Choice POS Fee Schedules 0103
SizePrint or DownloadOrder 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)
 
Help?
English
SizePrint or DownloadOrder Quantity
 AG NWS Rate Sheet English
9 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 AG NWS Rate Sheet Spanish
8 KB
 
Western Slope (WS)
 
Help?
English
SizePrint or DownloadOrder Quantity
 AG WS Plan Rate Sheet English
9 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 AG WS Rate Sheet Spanish
8 KB
 
Select Choice Dental Plan (SC)
 
Non-Western Slope (NWS)
 
Help?
English
SizePrint or DownloadOrder Quantity
 SC NWS Rate Sheet English
9 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 SC NWS Rate Sheet Spanish
8 KB
 
Western Slope (WS)
 
Help?
English
SizePrint or DownloadOrder Quantity
 SC WS Rate Sheet English
9 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 SC WS Plan Rate Sheet Spanish
8 KB
 
Triple Choice Dental Plan (TC)
 
Non-Western Slope (NWS)
 
Help?
English
SizePrint or DownloadOrder 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
 
Help?
Spanish
SizePrint or DownloadOrder 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)
 
Help?
English
SizePrint or DownloadOrder 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
 
Help?
Spanish
SizePrint or DownloadOrder 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)
 
Help?
English
SizePrint or DownloadOrder Quantity
 BGO NWS Enrollment Packet
244 KB
 
Western Slope (WS)
 
Help?
English
SizePrint or DownloadOrder Quantity
 BGO WS Enrollment Packet
245 KB
 
Help?
Discount Services
SizePrint or DownloadOrder Quantity
 Color Discount Flier w-ID Card
180 KB
 
Indemnity and PPO Plans
 
Companion Life
 
Help?
Companion Life Forms
SizePrint or DownloadOrder Quantity
 Covered Services Sheet
51 KB
 Employee Enrollment Form
40 KB
 Employer Agreement
35 KB
 
Securian Dental
 
Help?
Colorado Groups
SizePrint or DownloadOrder 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
 
Help?
General Forms
SizePrint or DownloadOrder Quantity
 Who is Beta Health
27 KB
 Why Securian Dental
41 KB
 
Help?
Non-Colorado Groups
SizePrint or DownloadOrder 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
 
Help?
English
SizePrint or DownloadOrder Quantity
 All Products Provider Directory-English
55 KB
 Alpha Provider Directory-English
48 KB
 Participating Specialist Directory
33 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 All Products Provider Directory-Spanish
37 KB
 Alpha Provider Directory-Spanish
29 KB
 
Securian Directories
 
Help?
Securian Provider Directories
SizePrint or DownloadOrder 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
 
Help?
English
SizePrint or DownloadOrder Quantity
 SC Employee Enrollment Packet-English
245 KB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 SC Employee Enrollment Packet-Spanish
285 KB
 
Triple Choice Material (TC)
 
Employee Enrollment Packets
 
Help?
English
SizePrint or DownloadOrder Quantity
 TC Employee Enrollment Packet-English
3389 MB
 
Help?
Spanish
SizePrint or DownloadOrder Quantity
 TC Employee Enrollment Packet-Spanish
380 KB
 
Employer Material
 
Help?
Employer Agreement Kit
SizePrint or DownloadOrder Quantity
 TC BHA Employer Agreement
99 KB
 TC Companion Life Employer Agreement
35 KB
 
Help?
Employer Proposal
SizePrint or DownloadOrder Quantity
 TC Employer Proposal with Rate Sheets
480 KB
 
Vision Plan Material
 
Help?
Vision Plan Forms
SizePrint or DownloadOrder Quantity
 Vision Plan Enrollment Brochure
52 KB
 Vision Plan Group Agreement
29 KB
 Vision Provider Directory-Statewide-10106
22 KB


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

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