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).
Small Group Forms for Brokers
Easily access and download all the small group forms and applications.
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
