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Application for Group Dental Coverage Application is made to Companion Life Insurance Company for a Dental Policy, the provisions of which shall be made available to all eligible classes of Employees.

Company address: Main Street Address b. City: State: Zip or Postal Code c. Telephone number: d. E-mail address: Employee-Support Center e. Dental office address: Main Street Address and Suite 110, 3rd Floor f. Dental office location: c/o Companion Life Insurance Company, P.O. Box 1088, Columbus, OH 43211 g. Dental office address line 2: c/o Companion Life Insurance Company, 2200 N. 2nd Street, Suite 130, Columbus, OH 42903 h. Name of employee: JOHN W. JOHN H. SZYMON 2. 2. 3. 4. 5. Dental insurance paid per year: 1 to 20,000; 2 to 100,000; 3 to 100,000 and annual; 4 to 50,000; 5 to 50,000 and annual; 6 to 10,000; 7 to 10,000 annual. d. Dental insurance amounts payable: 1. First year: 1/12 of 50 a year; 2; 2/12 of 60 a year; 3; 3/12 of 70 a year; 4. Second year: 1/4 of 25 a year; 2; 2/4 of 30 a year; 3 and 4. Third year: 1/28 of 30 a year; 5. Fourth year: 1/72 of 30 a year; Note: Dental insurance in lieu of cash payout is available for 1/3 of the amount payable annually up to 15,000 a year. d. No insurance for pre-existing disorders not covered by medical insurance policies (see Section 5, Medical). 6. Pay-out schedule: 1. Amount payable in first year: 1.75 2. Amount payable annually: 1.50 a day, or 25 a year. c. Dental insurance must be provided: 1. A minimum of one year from effective date of Dental Policy; 2. One year after the date covered with dental coverage or up to 10 years from date of coverage covered, whichever occurs first (whichever occurs first) 3. The first year of Dental Insurance and all previous years, unless it is terminated by the insured Employee's request at the time of application, during the 1st year or during the 6 calendar months starting on the date of application. 4.

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What is tda-ppo tda-companion elite choice?

The tda-ppo tda-companion elite choice is a benefits plan offered to employees. It provides access to a preferred-provider organization (PPO) for dental services and also includes a companion elite choice program.

Who is required to file tda-ppo tda-companion elite choice?

Employees who are eligible for the benefits plan are required to file the tda-ppo tda-companion elite choice.

How to fill out tda-ppo tda-companion elite choice?

To fill out the tda-ppo tda-companion elite choice, employees need to complete the provided form with their personal information and make selections for the dental services and companion elite choice program.

What is the purpose of tda-ppo tda-companion elite choice?

The purpose of tda-ppo tda-companion elite choice is to provide employees with access to a preferred-provider organization for dental services and offer additional companion elite choice benefits.

What information must be reported on tda-ppo tda-companion elite choice?

The tda-ppo tda-companion elite choice form requires employees to report their personal information, such as name, employee ID, and contact details. They may also need to provide information related to their dental coverage preferences and selections for the companion elite choice program.

When is the deadline to file tda-ppo tda-companion elite choice in 2023?

The deadline to file tda-ppo tda-companion elite choice in 2023 has not been announced yet. Please refer to the official communication or contact the relevant department for the deadline information.

What is the penalty for the late filing of tda-ppo tda-companion elite choice?

The penalty for the late filing of tda-ppo tda-companion elite choice may vary depending on the specific policies and guidelines of the benefits plan. It is recommended to review the official documentation or contact the benefits provider for accurate information regarding the penalty.

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