Dental

Participants that are able to participate in the Self-Pay Voluntary Dental Plan are those that are ELIGIBLE FOR HEALTH BENEFITS, which includes all of Self-Pay participants, and dependents. You and your dependents can enroll for coverage once you first become eligible for health benefits or between November 1 and November 30 of each year during the Plan's Annual Open Enrollment Period. For election during the Annual Open Enrollment Period, the coverage effective date will be the first day of the following year, January 1.
Note: If you are newly eligible and selecting Dental DHMO coverage your Premium payment cannot be processed without a Dental Application with a Primary care Dental Office selected. You can download the form as a PDF file by clicking the link below.
Dental Enrollment Form
Or call the office to have a copy mailed to you.

http://www.equityleague.org/PDF/forms/dental_enroll.pdf