Forms and Resources

We’ve got you covered! Get all the resources you need — including forms, benefit materials, and oral health resources — to better manage your dental benefits plan.

Forms

Group Authorization - Insured
Group Authorization - Self-Insured
Dependent Verification Request
Employee Enrollment / Change Form - (Dental)
Employee Enrollment / Change Form - (Vision)
Group Supplies Order Form
Payment Option Form - Fully Insured and Vision
Payment Option Form - Monthly Billed ASO
Payment Option Form - Weekly Billed ASO
Termination Report Form

Brochures & Flyers

Access Your Member Benefits 24/7
Access Your Member Benefits 24/7 - Spanish

Important Forms and Resources

Compliance

Individual Release of PHI Authorization
HIPAA Privacy Notice

eBilling

eBilling offers you the following features:

Online access to your bills through a secure portal.
Email notification when bills are issued.
Ability to export and save bills in Excel or PDF format.
Make an electronic payment from your bank account.
Ability to allow multiple users to receive the email notification and access bills.

eBilling

Open Enrollment

Maximizing the Value of Open Enrollment Season

View Open Enrollment information

Forms and Resources

eBilling

Open Enrollment

Benefits

About Us

Other Links

Tools