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Step 2 of 6: Your needs

Dental, Vision and Hearing

Dental, vision and hearing plans are designed to help with routine care and certain services. Benefits, waiting periods and limitations vary by plan.

Submitting an interest form does not guarantee coverage or payment for an existing or already scheduled procedure.

Coverage needed for *

IndividualCoupleFamily

Age or age range *

Under 3030–3940–4950–5960–6970 or older

Benefits of interest

DentalVisionHearingAll three

Current coverage status

No current coverageSome coverageCoverage ending soonNot sure

Desired coverage date

Preferred monthly-budget range

Under $50 per month$50 to $100 per month$100 to $200 per month$200 to $400 per monthMore than $400 per monthNot sure yet

Immediate area of interest

Routine dental careMajor dental procedureEye examinationEyeglasses or contact lensesHearing examinationHearing devicesGeneral future coverage

Additional comments

Your Future. Well Protected.

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Dental, Vision and Hearing

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Wells Insurance Group is an independent insurance agency. Submitting information does not guarantee approval, premiums, savings, subsidies or coverage. Plan availability and benefits vary.

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