Notice
June 19: Customer Service will be closed in observance of Juneteenth. Juneteenth commemorates the end of slavery in the United States on June 19, 1865. Not familiar with Juneteenth, learn more about Juneteenth.
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).
Small Group Forms for Brokers
Small Business Dental Plan Forms for 2-50 Enrolled Employees
Easy employer application (PDF, 9 pages, 1,930 KB)
Download our easy group application for 2-50 business
Simple dental employee enrollment (PDF, 1 page, 204 KB)
Download our easy dental group enrollment form for 2-50 business
Simple vision employee enrollment (PDF, 1 page, 204 KB)
Download our easy vision group enrollment form for 2-50 business
Enrollment spreadsheet (Excel)
Download our easy group enrollment spreadsheet guide for 2-50 business
