If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms. If you have coverage through an advisor, use our personal insurance forms.  

Your online account makes it easy to submit your claims online or print forms that are pre-filled with your personal information.

Use this form to request reimbursement for dental expenses covered by your plan. You'll find instructions on how to return the completed form on the form itself.  

Download this form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save.