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. Billing notifications are emailed to the billing contact on file and invoices can be downloaded from the Benefit Manager Toolkit (BMT)Each group has a designated BMT administrator who controls additional user access and permissions. The BMT administrator is given instructions for setting up their account at implementation.

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 will be available in Benefit Manager Toolkit (BMT) about 2 weeks prior to the month being billed. The billing contact on file will receive an email notifying them that the invoice is available for download.
  • Premium payments are withdrawn on the first Friday following or coinciding with the 5th of the month. For example, the invoice for January is run on December 15. Premium payments are then withdrawn the first Friday after the 5th of January.

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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