Notice
May 22 - September 4: Customer Service hours are Monday through Thursday 8:00 AM to 6:30 PM EDT and Friday 8:00 AM to 1:00 PM EDT.
To view benefit information and claim status at any time, you can sign into your account or use our Interactive Voice Response System 24/7 at (800-452-9310).
Notice
May 22 - September 4: Customer Service hours are Monday through Thursday 8:00 AM to 6:30 PM EDT and Friday 8:00 AM to 1:00 PM EDT.
To view benefit information and claim status at any time, you can sign into your account or use our Interactive Voice Response System 24/7 at (800-452-9310).
Dental Forms Library for Employers
Easily download and submit the form or application that relates to your needs.
Authorization Form Granting Access to PHI (PDF, 1 page, 52kb)
Eligibility Enrollment Change Form (Dental and Vision) (PDF, 2 pages, 22kb)
Use this form to submit new adds, changes, and terminations.
Disabled dependent verification certification (PDF, 1 page, 13kb)
This form officially certifies the dependency status of a disabled dependent. To be signed by the child's physician.
