Notice

On May 21st, our call center will operate from 8 AM to 11:45 AM and will be closed in the afternoon.

From Friday May 23rd through Friday, August 29, 2025: Customer Service hours will be 8:00 AM – 6:30 PM EST Monday through Thursday and 8:00 AM - 1:00 PM EST on Friday.

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

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.