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ISDA Investigates Association Health Plan

The Idaho State Dental Association is actively working on developing a statewide Association Health Plan. In order to proceed we would need 200 individuals to participate; and we need to gather basic information from members who might be interested in participating to get a rate estimate. If you are interested (assuming we have a competitive offer) please submit the name, date of birth, and zip code of employees, and their dependents, in your office who might participate

This does not bind any employees or employers to participating in a plan.  It just gives the carriers enough information to proceed with developing options.

Name, DOB (mm/dd/yyyy), Zip Code
Person 1 Gender:

Name, DOB (mm/dd/yyyy), Zip Code
Person 2 Gender:

Name, DOB (mm/dd/yyyy), Zip Code
Person 3 Gender:

Name, DOB (mm/dd/yyyy), Zip Code
Person 4 Gender:

Name, DOB (mm/dd/yyyy), Zip Code
Person 5 Gender:

Name, Phone Number, Email
If you would prefer to fax this information in to the ISDA office instead of submitting an online form, please use the document below and fax it in to 208-343-0775.
"State":"ID"