Employers
Forms and FAQ's
Forms
Employee Enrollments - Fill in and/or Download Forms
Employee Enrollment Form - Employee enrollment form for Group Plans.
Employee Enrollment Form (Spanish) - Employee enrollment form for Group Plans.
Group Applications / Downloadable Forms
All Plans Application - Contributory / Voluntary Group Dental Plan Application.
Change Forms
Miscellaneous
Helpful Benefit Hints - Get the most out of your dental plan.
Vision
EyeMed Vision Out-of-Network Claim Form
Online Forms
FAQ's
How do I add or cancel an employee?
You may add or cancel an employee during open enrollment, or within 31 days of a qualifying event: marriage, divorce or legal separation, birth of a child or adoption of a child, loss of employment, new employment, or death of insured.
All additions and cancellations will be effective on the first of the month following any waiting periods.
When cancelling an employee, the effective date of change must be the final day of the last covered month. A member can be cancelled back to the 1st of the current month only when Dental Select receives the cancellation notice on or before the 15th of that month. If Dental Select receives the cancellation notice after the 15th of the month, member will be cancelled the last day of that month. As long as no claims have been processed, a member may be cancelled back two (2) months.
When will ID Cards arrive? How do I order replacement ID Cards?
ID Cards will arrive approximately 7 - 10 days from the time Dental Select receives the enrollment or change form.
Two ID cards are mailed in a certificate booklet format. Please instruct employees to bring one card with them to their appointment so that the provider is aware of their dental plan and can discount the charges accordingly. The other card is included for their convenience.
If an employee loses their ID card, please instruct them to contact Member Services at 1-800-999-9789.
How do I request supplies?
You can request supplies for your group by:
- Calling the Supplies Department at (800) 999-9789, or
- Fax a completed supply request form located in the above Forms section.
How can I obtain additional information on HIPAA?
Dental Select is HIPAA compliant. For more information on HIPAA visit the following websites:
US Department of Health & Human Services
http://www.dhhs.gov/ocr/hipaa/
Center for Medicaid Services
Forms
Employee Enrollments - Fill in and/or Download Forms
Employee Enrollment Form - Employee enrollment form for Group Plans.
Employee Enrollment Form (Spanish) - Employee enrollment form for Group Plans.
Group Applications / Downloadable Forms
All Plans Application - Contributory / Voluntary Group Dental Plan Application
Change Forms
Miscellaneous
Helpful Benefit Hints - Get the most out of your dental plan.
Vision
EyeMed Vision Out-of-Network Claim Form
FAQ's
How do I add or cancel an employee?
You may add or cancel an employee during open enrollment, or within 31 days of a qualifying event: marriage, divorce or legal separation, birth of a child or adoption of a child, loss of employment, new employment, or death of insured.
All additions and cancellations will be effective on the first of the month following any waiting periods.
When cancelling an employee, the effective date of change must be the final day of the last covered month. A member can be cancelled back to the 1st of the current month only when Dental Select receives the cancellation notice on or before the 15th of that month. If Dental Select receives the cancellation notice after the 15th of the month, member will be cancelled the last day of that month. As long as no claims have been processed, a member may be cancelled back two (2) months.
When will ID Cards arrive? How do I order replacement ID Cards?
ID Cards will arrive approximately 7 - 10 days from the time Dental Select receives the enrollment or change form.
Two ID cards are mailed in a certificate booklet format. Please instruct employees to bring one card with them to their appointment so that the provider is aware of their dental plan and can discount the charges accordingly. The other card is included for their convenience.
If an employee loses their ID card, please instruct them to contact Member Services at 1-800-999-9789.
How do I request supplies?
You can request supplies for your group by:
- Calling the Supplies Department at (800) 999-9789, or
- Fax a completed supply request form located in the above Forms section.
How can I obtain additional information on HIPAA?
Dental Select is HIPAA compliant. For more information on HIPAA visit the following websites:
US Department of Health & Human Services
http://www.dhhs.gov/ocr/hipaa/
Center for Medicaid Services
Forms
Employee Enrollments - Fill in and/or Download Forms
Employee Enrollment Form - Employee enrollment form for Group Plans.
Employee Enrollment Form (Spanish) - Employee enrollment form for Group Plans.
Group Applications / Downloadable Forms
All Plans Application - Contributory / Voluntary Group Dental Plan Application
Change Forms
Miscellaneous
Helpful Benefit Hints - Get the most out of your dental plan.
Vision
EyeMed Vision Out-of-Network Claim Form
FAQ's
How do I add or cancel an employee?
You may add or cancel an employee during open enrollment, or within 31 days of a qualifying event: marriage, divorce or legal separation, birth of a child or adoption of a child, loss of employment, new employment, or death of insured.
All additions and cancellations will be effective on the first of the month following any waiting periods.
When cancelling an employee, the effective date of change must be the final day of the last covered month. A member can be cancelled back to the 1st of the current month only when Dental Select receives the cancellation notice on or before the 15th of that month. If Dental Select receives the cancellation notice after the 15th of the month, member will be cancelled the last day of that month. As long as no claims have been processed, a member may be cancelled back two (2) months.
When will ID Cards arrive? How do I order replacement ID Cards?
ID Cards will arrive approximately 7 - 10 days from the time Dental Select receives the enrollment or change form.
Two ID cards are mailed in a certificate booklet format. Please instruct employees to bring one card with them to their appointment so that the provider is aware of their dental plan and can discount the charges accordingly. The other card is included for their convenience.
If an employee loses their ID card, please instruct them to contact Member Services at 1-800-999-9789.
How do I request supplies?
You can request supplies for your group by:
- Calling the Supplies Department at (800) 999-9789, or
- Fax a completed supply request form located in the above Forms section.
How can I obtain additional information on HIPAA?
Dental Select is HIPAA compliant. For more information on HIPAA visit the following websites:
US Department of Health & Human Services
http://www.dhhs.gov/ocr/hipaa/
Center for Medicaid Services
