Notice
Monday, January 19: Our Customer Service center will be open from 8:00 a.m. to 5:00 p.m. in observance of Martin Luther King Jr. Day and will have reduced staffing levels which may result in longer wait times than usual . 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 (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.
