To apply for INDIVIDUAL / FAMILY coverage:
Download application and rate schedule
Go to Frequently Asked Questions for Individuals

To apply for GROUP coverage:
Download application for Employer Participation
Go to Frequently Asked Questions for Groups

If you are a dentist and want to join our Olympia Dental network:
Please contact us directly

To apply to be a BROKER for Olympia Dental:

For New Brokers with no General Agent (GA) affiliation, the following forms need to be completed:

Producer Sales Agreement Form 11104
Writing Producer Appointment Application Form 11105
Broker Compensation Worksheet Form 11106

For New Brokers with General Agent (GA) affiliation, the following forms need to be completed:

Writing Producer Appointment Application Form 11105
Broker Compensation Worksheet Form 11106

For New General Agents (GA), the following forms need to be completed:

General Agent Sales Agreement Form 11101
General Agent Appointment Application Form 11102
General Agent Compensation Worksheet Form 11103

For all of the above:
Copy of current Producer License

Copy of Agency License (if applicable)
Go to Frequently Asked Questions for Brokers