Choice Builder

Choice Builder gives employers with 2-199 employees access to some of the nations premier dental, vision, chiropractic and life carriers – all in one program. Whether you’re already offering optional benefits, or looking to add them for the first time, with Choice Builder you can pick and choose the benefits you like best and build a program that makes sense for your business, your budget and your employees.

 Provider Finder 

Form Name Effective Date Download Form
Administrative Guidelines for Employers
04/01/2017 Download
Case Submission Checklist
Download
Employee Termination Form
Download
Employer Application
04/01/2017 Download
Employer Application
12/01/2016 Download
Employer Change Request Form
04/01/2017 Download
Employer Change Request Form
12/01/2016 Download
Initial Payment Form (One-Time ACH)
Download
Late Submission Acknowledgment
Download
Owner/ Partner Statement
Download
Prior Carrier Cancel Template
Download
Form Name Effective Date Download Form
Change Request Form
04/01/2017 Download
Change Request Form
12/01/2016 Download
Enrollment Form
04/01/2017 Download
Enrollment Form
12/01/2016 Download
VSP Claim Form
Download
Form Name Effective Date Download Form
Dental
Benefit Summary Sales
Summary
Ameritas Gold Schedule of Benefits - No Ortho
Summary
Ameritas Gold Schedule of Benefits - With Ortho
Summary
Ameritas Platinum Schedule of Benefits - No Ortho
Summary
Ameritas Platinum Schedule of Benefits - With Ortho
Summary
Ameritas Silver Schedule of Benefits - No Ortho
Summary
Ameritas Silver Schedule of Benefits - With Ortho
Summary
Delta Care USA
Summary
Delta PPO Gold
Summary
Delta PPO Platinum
Summary
Delta PPO Silver Vol
Summary
Other
Employee Enrollment Guide
Summary
Form Name Effective Date Download Form
Choice Builder Sales Brochure
Download
Employee Enrollment Guide
Download
Benefit Summary Sales
Download
POP Flyer
Download
Program Highlights Rogers SD
Download
Provider Search
04/01/2017 Download
Quote Program Guide
Download
Underwriting Guidelines
Download
Form Name Effective Date Download Form
Choice Builder Contact Sheet
Download