Forms are available through the links below. Each form can be downloaded, printed, and completed. Then you can fax or send the form in to us. All of our forms are in portable document format (pdf). Therefore, you will need Adobe Acrobat Reader to view them. If you have custom or proprietary forms, please enter your group number in the form below and push submit. You will be taken to a page containing those forms.
 
Custom Forms
Enter Group Number:
DentAssure Dental Plan Employer Application
Employee Application 
Flexible Spending Accounts (FSAs)

Flex Enrollment Form 
Medical Reimbursement Account Claim Form
Dependent Care Claim Form
SMRA Claim Form