Notice

June 5, 2020: Member and Dentist secure websites are currently unavailable. We are sorry for the inconvenience and thank you for your patience while we work to restore this feature.

Our Interactive Voice Response System (IVR) is operational 24/7 for self-service at 800-452-9310.

Notice

Our call center is open 8 AM – 4:30 PM Eastern time Monday – Friday. We are working with reduced staff, therefore you may experience longer than normal wait times. Learn more about how we’re continuing to serve our customers during this time.

Small Group Forms for Brokers

Easily access and download all the small group forms and applications.

Small Business 2-50 Enrolled Employees

Easy Employer Application (PDF, 3 pages, 377 KB)
Download our easy group application for 2-50 business

Simple Employee Enrollment (PDF, 1 page, 204 KB)
Download our easy group enrollment form for 2-50 business