NATIONAL BENEFITS CONSULTANTS
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SUNLIFE pREPAID Dental Plan
Enrollment form and payment must be received by the 15th of the month in order to begin coverage on the 1st day of the following month. When your enrollment is processed, membership confirmation will be e-mailed to you. You may make an appointment with your selected dentist at anytime after your effective date of coverage. Make sure to select a dental office when you enroll and upload your payment information prior to submitting your application. Please call 720-488-9892 if you have any questions. The required PDF payment form "Charge Card Authorization" can be found at the bottom of this page.
- Click here to view the Dental Plan Benefits for Auraria Campus Students (PDF) -
Online Enrollment Form-
*
Indicates required field
Name
*
First
Last
Email
*
Phone Number
*
Employer / School
*
Mailing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Gender
*
Male
Female
Social Security Number
*
Date of Birth
*
Dental Facility ID
*
To select a dental office click here
Enter the ID# in the box to the left
Coverage Type
*
Single - $12.15
Member + One - $20.02
Family - $31.02
Spouse
*
First
Last
Date of Birth
*
Child #1
*
First
Last
Date of Birth
*
Child #2
*
First
Last
Date of Birth
*
Child #3
*
First
Last
Date of Birth
*
Child #4
*
First
Last
Date of Birth
*
Upload Charge Card Authorization Form. See below.
*
Max file size: 20MB
Agent
*
Submit
Additional Required Forms
charge_authorization_form.pdf
File Size:
86 kb
File Type:
pdf
Download File
Home & Information
PPACA / ObamaCare Guide
Buyer's Guide - Health Insurance
Understanding Insurance
Health & Life Plans
Group Health Plans
>
Submit Group Census
Disability Insurance
Individual Health
Life Insurance
Medicare Supps & Part D Rx
Short Term Medical
Travel Insurance
Home, Auto & Business
Upload Policy For Review
Instant Quotes
Dental Insurance
>
Prepaid Dental Application
Home Health Care
Individual Medical
Life Insurance
Limited Medical Benefit Plan
LTD - STD - Critical Illness
Medical Evacuation
Medicare Supp
Pet Insurance
Rx & Healthcare Card
Short Term Medical
Tel-A-Doc
Travel Insurance
Forms
Life Forms & Apps
Health Forms & Apps
The Staff
More About Us
Contact Us
Terms & Conditions