Friday, September 29, 2023: Customer Service hours will be 9:00 AM - 4:00 PM ET. We apologize for any inconvenience this may cause.

To view benefit information and claim status, self-service by signing into your account or using our Interactive Voice Response System (IVR) 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.