Notice
We’re experiencing a high volume of calls and emails, causing delays in response times. We apologize for any inconvenience and appreciate your patience.
On November 19th, the Call Center will be open from 8:00 AM to 11:45 AM ET due to team training.
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
Easily download and submit the form or application that relates to your needs.
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.
