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)

Enrollment/Change Form (Dental) (PDF, 2 pages, 627kb)
Use this form to submit new adds, changes, and terminations.
Enrollment/Change Form (Vision) (PDF, 1 pages, 378kb)
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.