Notice
Customer Service will be closed on Friday, April 18, 2025 for Good Friday. 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.
