What's Needed to Quote

If you’d like to get a quote for your business, please complete the form below and note that Delta Dental of Illinois requests the following items:

Census (total benefit eligible employees) with date of birth, gender, home ZIP code, plan, tier elections and current product (not necessary for small groups with 2 to 150 eligible employees)
SIC code
In-force carrier, plan design, current and/or renewal rates (if applicable)
Claims experience (24 months – if available)
Employer contribution
Commission level (if applicable)

Brokers who represent small businesses in Illinois can get a quote using our small group quote tool.

Request a Quote

Please complete this form using Google Chrome or Safari.

All fields marked with * are required.

Who is requesting this proposal?

First Name *

Last Name *

Company Name *

Title

Email *

Phone *

Tell us about the group you are quoting.

Company Name *

Street Address *

City *

State *

Zip Code *

Type of Business *

Number of full-time employees? *

Are you headquartered in Illinois? *

Which products would you like a quote for? *

Do you currently offer dental insurance? *

If YES, list carrier.

Do you work with a broker or consultant? *

If YES, list Broker or Consultant

Is there anything else we should know?

Enter additional information you want us to know.