Notice
System maintenance will take place this weekend from Friday 10/16 to Sunday 10/18 where services will be limited. During this time, Claims Submissions, Eligibility Updates, Procedure code lookup, and Website information will be current as of Friday and updated once maintenance is complete.
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.
