All of the requirements below must be
submitted together to Canyon Insurance
Services, Inc. (CIS) for installation of
a new group. If any of the listed
items are missing or incomplete,  there
may be a delay in processing.
- Master Application:
Original returned,
completed and signed
- Employee Enrollment
Forms: All
employees enrolling must complete an
enrollment form
- 1st Month’s Premium
Check: Based
on actual enrollment and cannot vary
by more than 10% from actual amount
required
- For All Vision Plans: A minimum of 3
(three) employees must enroll in order to
issue a contract
- Employer Paid Plans: Employer must
contribute 99% of the employee premium
or the vision plan enrollment must be
bundled with either a group medical or
group dental plan
- Broker Forms: Brokers that have not
previously sold a Canyon Insurance
product will need to complete the
following forms, which will be sent upon
notification to CIS of a new case:
- Agent Agreement
- Addendum to Agents Agreement
- W9 Form
DeltaVision® is offered through Canyon Insurance Services, Inc., a wholly owned subsidiary of Delta Dental of Arizona, in partnership with EyeMed Vision Care, LLC.
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