Notice
Monday, May 25: Our offices will be closed in observance of Memorial Day. Warm wishes to you and your family as we honor and remember the brave men and women who sacrifice in service of our nation.
May 22 - September 4: Customer Service hours are Monday through Thursday 8:00 AM to 6:30 PM EDT and Friday 8:00 AM to 1:00 PM EDT.
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
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.
