individuals
  • Save on all dental care
  • Save all year long
  • Up to 50% savings

couples
  • Liberal Definition
  • Save on every procedure
  • No waiting period

families
  • Save on pediatric dental
  • Save on braces
  • Save on entire family

seniors
  • Save on dentures, bridges
  • No age limitations
  • No annual limit
Enrollment Form
* Required Fields
This plan is available in Massachusetts, Connecticut, and now the Palm Beach area of Florida.
Subscriber Information
First Name*
Last Name*
Gender
Address*
Address 2
City
State
Zip*
Phone*
Agent ID
Email*
Select a Plan
Senior Plans
Senior Couples ($114.85 Annual Recurring)
Senior Couples ($9.60 Monthly Recurring)
Senior Family ($12.39 Monthly Recurring)
Senior Family ($148.75 Annual Recurring)
Senior Individual ($6.75 Monthly Recurring)
Senior Individual ($80.75 Annual Recurring)
Individual Plans
Individual ($7.95 Monthly Recurring)
Individual ($95.00 Annual Recurring)
Couples Plans
Couple (Liberal Definition) ($11.25 Monthly Recurring)
Couple (Liberal Definition) ($135.00 Annual Recurring)
Family Plans
Family (Unlimited Members) ($14.60 Monthly Recurring)
Family (Unlimited Members) ($175.00 Annual Recurring)
Coupon Information
Enter Coupon Code
Additional/Dependent Information (If choosing a Couples plan, please enter only 1 dependent)
Member’s Name Who Referred You
Your Birthday (mm/dd/yyyy)
Dependant 1 Name
Dependant 2 Name
Dependant 3 Name
Dependant 4 Name
Dependant 5 Name
How did you find us?
Payment Information
Card Holder Name*
Card Type*
Card Number*
Expiration Date
(Month/Year)*		/
CVV2 Code (What's This?)
Terms and Conditions
Yes, I have read and agreed with the terms and conditions.
(This plan is currently only available in Massachusetts and Connecticut.) View Terms