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SERVICE AGREEMENT - Golden West Dental and Vision

SERVICE AGREEMENT - Golden West Dental and Vision 2025

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4.7 out of 5

55 votes

The document outlines the requirements and agreements necessary for agents to receive commission payments from Golden West Dental & Vision. It includes instructions for submitting an Agent Profile, Service Agreement, Business Associate Agreement, and various forms such as a current license and W9 form. The document details the obligations of the agent, including compliance with laws, handling of premiums, and maintaining confidentiality of protected health information (PHI). It also specifies terms regarding compensation, termination of the agreement, and indemnity provisions.

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Click ‘Get Form’ to open the SERVICE AGREEMENT in the editor.
Begin by filling out the Agent Profile section. Enter your name, business name, and contact information accurately. Ensure that all fields are completed as this information is crucial for commission payments.
Proceed to the Agent Service Agreement section. Review the obligations outlined for agents, ensuring you understand your responsibilities regarding solicitation and remittance of premiums.
In the Compensation section, note the details about monthly commissions. Fill in any required fields related to your commission structure and ensure you understand how changes may affect your earnings.
Complete the Business Associate Agreement section if applicable. This includes understanding privacy obligations under HIPAA and ensuring compliance with all relevant laws.
Finally, review all sections for accuracy before signing. Use our platform’s features to add your signature electronically where indicated.

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Versions	Form popularity	Fillable & printable
2009	4.7 Satisfied (55 Votes)
2003	4 Satisfied (37 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is dental insurance considered health insurance for taxes?

If you purchased insurance for medical and dental care and paid the premiums out of pocket with after-tax dollars, you can claim the amount as a deduction on your return.

Does vision insurance count as health insurance for taxes?

You can deduct vision insurance premiums, eye exams and eye surgeries from your taxes if you paid for those expenses out of pocket. But, any costs covered by a vision insurance plan are not tax deductible. Additionally, you cant deduct any portion of your insurance premium that your employer-paid.

Is dental and vision insurance considered health insurance?

Health insurance companies do not offer vision and dental as a core plan benefit. The Affordable Care Act (ACA) excludes adult vision and dental as one of the 10 essential health benefits that health plans must provide. Excluding vision and dental helps health insurance companies keep premiums low.

Who pays the dental practice for services under direct reimbursement?

Direct Reimbursement (DR) Depending on the plan, the patient pays the dentist directly (or the benefit may be directly assigned to the dental office) and then submits a paid receipt or proof of treatment. The administrator then reimburses the employee a percentage of the dental care costs.

Is dental insurance considered health insurance in the USA?

A dental plan is a separate insurance policy from health insurance. As with health insurance, a dental plan requires you to pay certain costs, such as a deductible, premiums, copayments, and coinsurance.