Group Dental Insurance

Requirements for Dental Enrollment
(Group size 3-50)

Membership Applications

• Must be dated and signed by employee.
• Must be completed by each employee enrolling in dental product.

Waiver Forms

• Required for all eligible employees not enrolling in dental product.
• Required for all employees waiving BCBS health but enrolling in dental.
  • All existing BCBS health groups should have waivers on file already. If your client does not have copies of waivers for employees not enrolled in health but enrolling in dental, health waivers will be required in order to enroll these employees in dental.

Sales Agreement

• Sales Agreement must be completed in full.
• Sales Agreement must be dated and signed by employer and broker.

Payroll Documentation

Deposit Check

• Made payable to Blue Cross and Blue Shield of RI
• Not required on existing BCBS health groups

Copy of most Recent BCBS Health Bill

• Required on existing BCBS health accounts only.
• It is important to note that any subscribers with a difference in enrollment status between health and dental will receive separate ID cards for each product. All other employees will receive one ID card for both medical and dental.
  • Single health and family dental = two ID numbers and two ID cards
  • Family health and family dental = one ID number and one ID card
  • Remind your client that for employees that are assigned two separate Membership ID numbers, two Group Activity Report line items will be required to terminate them (i.e., one for Health and one for Dental).