Ancillary Documents

Disability Quote Request Form

California Printable Disability Quote Request Form (PDF)

California Disability Quote Request Form (Excel)


Ancillary Employee Worksheet Templates‚Äč

When you need a rate worksheet for your dental, vision and life offerings that have customized rates and guidelines, select the template that suits you best.  Notice they are available in 3 and 4 tier layouts.  You can choose a format that displays the contribution, or just the employee cost which is perfect for voluntary offerings.  Multiple plans, or single options and customizable logo upload fields and notes at the bottom make these user friendly!


Single Plan 3 Tier Contribution Ancillary Rate Sheet (PDF)

Single Plan 4 Tier Contribution Ancillary Rate Sheet (PDF)

Single Plan 3 Tier Employee Payroll Deduction Ancillary Rate Sheet (PDF)

Single Plan 4 Tier Employee Payroll Deduction Ancillary Rate Sheet (PDF)

MultiPlan 3 Tier Contribution Ancillary Rate Sheet (PDF)

MultiPlan 4 Tier Contribution Ancillary Rate Sheet (PDF)

MultiPlan 3 Tier Employee Payroll Deduction Ancillary Rate Sheet (PDF)

MultiPlan 4 Tier Employee Payroll Deduction Ancillary Rate Sheet (PDF)


 
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