Forms & Resources

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• Finding a Network Dentist

• Finding a Vision Provider

• **Authorization Form** - Authorization to release personal health information
  
  
• **Personal Representative Form**
  
  
• Dental Enrollment/Change/Waiver Form — Click the appropriate link below to download. In order to use a the fillable form, save the PDF to your computer and open it using Adobe® Reader® rather than your browser.
• English
• Spanish
• Hmong

• Vision Enrollment/Change/Waiver Form — Click the appropriate link below to download. In order to use a the fillable form, save the PDF to your computer and open it using Adobe® Reader® rather than your browser.
• English
• Spanish
• Hmong

• Dental and Vision Enrollment/Change/Waiver Form — Click the appropriate link below to download. In order to use a the fillable form, save the PDF to your computer and open it using Adobe® Reader® rather than your browser.
  • English
  • Spanish
  • Hmong

• ACH Form for Fully-Insured Groups — Make payments the easy way with ACH

• ACH Form for Self-Insured Groups — Make payments the easy way with ACH

• Dental Claim Form

• Vision Claim Form