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On October 10, we will be upgrading our phone system. This enhancement will improve your future experience. It may result in additional wait times during our transition. We appreciate your understanding and patience as we work to serve you better.

On October 10, our call center will be closed for staff training between 12 PM and 1 PM ET.
On October 9, due to the enhancement to our phone system, our IVR will be unavailable for self-service from 6.30 PM through 11:59 PM ET.

Dental Forms Library for Employers

Find the application or form that relates to your needs and easily download and print, or submit online.

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.