On Friday, March 31, 2023: Customer Service hours will be 9:45 AM  - 4:30 PM ET. We apologize for any inconvenience this may cause.

To view benefit information and claim status, self-service by signing into your account or using our Interactive Voice Response System (IVR) 24/7 at 800-452-9310.31

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 (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.