DentalandVisionIns.com
Printing Applications and Forms
 
You will need an Adobe Acrobat Reader to view and print these files.

Get Adobe Reader

 


Administration Instructions for Groups


Employee Application/Deletion or Change Form

Please use the Individual application for adding a new employee, deleting an existing
employee or changing dependent status on an existing employee's coverage. 
You can also use our web forms to report these changes

 

 

COBRA

Cal-COBRA groups will give us the members address upon termination of coverage and we will generate the Cal-COBRA election form and invoice the member directly for the coverage. 

Federal COBRA groups will need to issue a COBRA form upon the qualifying event.  
Click here for an Adobe Acrobat file of the Federal COBRA form.  
Members who extend coverage under Federal COBRA will be invoiced with the group and the individual premium collection is done by the group.

Please follow this link for a definition of Federal COBRA vs. Cal-COBRA and to notify us which COBRA regulations apply to your group.

 


Click here to view and print Certificates and Plan descriptions