Notice
Friday, April 10: Our Customer Service Center will be available from 10:00 AM to 5:00 PM, due to staff development.
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).
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
