ACH Authorization: Group Dental/Vision Plans

Use this secure form to sign up to pay your group's dental and/or vision premiums electronically through ACH or to update your ACH information. Note: Groups with fewer than 10 enrolled are required to use ACH as their payment. Groups with more than 10 enrolled are encouraged to use ACH, but are not required to do so.

Important Information

Be sure to review these docs:

Does your group have fewer than 10 enrolled?
We require groups with fewer than 10 enrolled employees to sign up for ACH. As a courtesy, an account for the Employer Connection will automatically be created for you. You will receive a secure email from us with your account information during implementation. The Employer Connection gives you access to update eligibility and view invoices.

Enrolling in ACH for the first time? Here's some key details to know:

  • ACH withdrawals will begin for the billing cycle after the form is received.
  • Invoices are run on the 15th of each month. You will receive an email around the 17th of each month that will include basic information on the amount of the withdrawal. You will need to sign in to the Employer Connection to view the invoice.
  • Premium payments are withdrawn on the first business day of each month.

Prefer to submit a paper ACH authorization instead of the online form?
That's fine. You can download the ACH Authorization for Group Dental/Vision Plans and send the completed form back to us. Submission information is on the form.


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