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 Documents

Beta Network Plans

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Change of Status Form

33 KB

Agents Documents

Size

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BHA Companion Life Agent Agreement Kit

474 KB

BHA Securian Colorado Agent Agreement

1174 MB

BHA Securian Non-Colorado Agent Agreement

585 KB

Alpha Individual Plan

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Beta Health Provider Directories

Beta Health Directories

English

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Spanish

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Securian Directories

Securian Provider Directories

Size

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Securian Colorado Provider Directory

72 KB

Careington CarePOS

Care POS Fee Schedules

Enrollment Specific Choice POS Fee Schedules 0103

Size

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1 National Choice POS State Fee Schedule Listing

33 KB

Care Series Plan Fee Schedule Guide

37 KB

CI-1 Care POS

41 KB

CI-10 Care POS

41 KB

CI-11 Care POS

41 KB

CI-12 Care POS

41 KB

CI-13 Care POS

42 KB

CI-2 Care POS

41 KB

CI-3 Care POS

41 KB

CI-4 Care POS

43 KB

CI-5 Care POS

43 KB

CI-6 Care POS

43 KB

CI-7 Care POS

43 KB

CI-8 Care POS

41 KB

CI-9 Care POS

41 KB

Discount Services

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Color_Discount_Flier_w-ID_Card

219 KB

EyeMed Vision Product

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Fee Schedules

Plan 17 Fee Schedule 2009

57 KB

Plan 18 Fee Schedule 2009

57 KB

Plan 19 Fee Schedule 2009

57 KB

Plan 20 Fee Schedule 2009

57 KB

Plan A Fee Schedule 2009

57 KB

Care POS Fee Schedules

Enrollment Specific Choice POS Fee Schedules 0103

Size

Print or Download

Order Quantity

1 National Choice POS State Fee Schedule Listing

33 KB

Care Series Plan Fee Schedule Guide

37 KB

CI-1 Care POS

41 KB

CI-10 Care POS

41 KB

CI-11 Care POS

41 KB

CI-12 Care POS

41 KB

CI-13 Care POS

42 KB

CI-2 Care POS

41 KB

CI-3 Care POS

41 KB

CI-4 Care POS

43 KB

CI-5 Care POS

43 KB

CI-6 Care POS

43 KB

CI-7 Care POS

43 KB

CI-8 Care POS

41 KB

CI-9 Care POS

41 KB

Rate Sheets

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

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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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