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 Benefit Manager Toolkit (BMT). 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 - Group Plan Members (English/Spanish)
Downloadable Form
Request/Change BMT Administrator
Online Fillable Form
Secure Document Upload Tool
Online Fillable Form
Additional Resources & Documents
Benefit Manager Toolkit User Manual
Informational Document
BMT Admin Registration Instructions
Informational Flyer
BMT User Registration Instructions
Informational Flyer
Eligibility Updates & Retroactive Termination Policy Guidelines
Informational Flyer
Printable Dentist Directory
Informational Document (updated monthly)
Benefit Manager Toolkit (BMT) Demo Videos
Navigating BMT
Adding a New User
Adding a Member
Adding a Dependent
Modifying a Member
Terminating a Member
Reinstating a Member
