Get Densource

Filling out the Densource form is an important step for users seeking dental coverage. This guide provides clear, step-by-step instructions to help you accurately complete the enrollment process online.

Follow the steps to complete your Densource enrollment form.

1. Click the ‘Get Form’ button to access the Densource enrollment form and open it in your editor.
2. In the required section, enter your department and division name along with the effective date of the coverage.
3. Provide your Social Security number as requested in Part 1.
4. Enter your name, including your last and first name, in the designated fields.
5. Fill in your address, including city, state, and zip code.
6. Provide your work phone number and home phone number.
7. Enter your date of birth in the format month/day/year.
8. Select your sex by circling either 'Female' or 'Male.'
9. List all eligible dependents you wish to have covered under your dental plan and include their dates of birth.
10. In Part 2, specify your relation to the dependents, as well as the selected dental location name.
11. Complete Part 3 if you are enrolling in the DHMO plan.
12. In Part 4, select your desired plan and coverage type from the options provided, including pricing information.
13. Review the payroll deduction authorization statement, confirming understanding and consenting to the monthly membership fees.
14. Sign and date the form to finalize your enrollment.
15. Complete Part 6 if you need to indicate participation in the State 125 Cafeteria Plan or any existing coverage termination.
16. Once the form is complete, save your changes, and choose to download, print, or share the document as needed.

Take the next step towards your dental coverage by completing your Densource enrollment form online today.