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Dental Insurance Quotes

Employer Enrollment Form

Employee Enrollment Form

Check List

Plan Coverage(Options PPO 20)

Plan Coverage(Voluntary Options PPO 20)

Member Guide

Basic Life Benefit Summary

Vision Benefit Summary

OBM - Elite vs Voluntary

Participation requirements

Elite Plan: Groups enrolling in Contributory plans must have at least 75% of the active eligible employees enrolled, excluding those waived with spousal coverage (not to fall below 50% of all eligible employees).

Voluntary Plan: Groups enrolling in Voluntary plans must have at least 2 people enrolling to be eligible for coverage.

*For orthodontia, an employer group must have a minimum of 10 enrolling employees. Orthodontia benefits are for dependent children only up to the age of 18.

OBM Enrollment Request

  • Fill up the Employer/Employee Form (see above)
  • Lastest Tax Document (NYS 45)
  • Copy of the Binder Check

Please mail the check to the following address:

Crystal Newell

225 Wireless Blvd, Suite 200
Hauppauge, NY 11788

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