ISDA Association Health Plan

The Idaho State Dental Association has established an Association Health Plan. This member benefit is available and ready! We need to gather basic information from members who might be interested in participating to get you a rate estimate. If you are interested please submit the name, date of birth, and zip code of employees, and their dependents, in your office who might participate

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"