Forms
ACH Authorization: Groups/Employers
Online Fillable Form
Employer Forms & Documents
Welcome to our library of employer/group forms and documents. Additional forms may be available in the Employer Connection. If you still can't find what you're looking for, please feel free to contact us.
Appeals & Grievances
Online Fillable Form
Electronic Check Payments
Online Fillable Form
Enrollment/Change of Status Form
Downloadable Form
Solicitud de Inscripción/Modificación
Downloadable Form
Generic Enrollment Spreadsheet - Dental/Vision
Downloadable Form
Group Enrollment File Upload Tool
Online Fillable Form
HIPAA Release (English/Spanish)
Downloadable Form
Request Employer Connection Access
Online Fillable Form
Secure Document Upload Tool
Online Fillable Form
Additional Resources & Documents
Eligibility Updates & Retroactive Termination Policy Guidelines
Informational Flyer
Employer Connection FAQs
Informational Flyer
Employer Connection Registration Instructions
Informational Flyer
Online Enrollment Manual for the Employer Connection
Informational Document
Printable Dentist Directory
Informational Document (updated monthly)
