Follow the steps to complete the enrollment form accurately.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering your first name, last name, and middle initial in the designated fields. Ensure that these names are spelled correctly, as they will be used for verification.
3. Fill in your complete address, including city, state, and zip code, along with a contact phone number. Indicate if you prefer to receive text messages regarding your enrollment updates.
4. Select your desired dental plan options from the choices provided. Confirm the available plans with your employer before making these selections.
5. Indicate your preferred vision plan by selecting the appropriate option. If applicable, mark the AD&D coverage option that fits your needs. Provide relevant details about your employment, including the date of hire, group number, and subgroup or department.
6. List individuals whom you are enrolling under the coverage. For each person, provide their date of birth, gender, and Social Security Number. Ensure all entries are accurate to avoid delays in processing.
7. If you are enrolling eligible dependents, ensure that you complete the respective details, including names, social security numbers, and any coverage desires for each dependent.
8. If you have a qualifying life event or additional enrollment requirements, indicate this information clearly in the designated section.
9. Review your entries for accuracy. Once you have completed filling out all sections of the form, you may save your changes, download, print, or share the completed form as needed.

Ensure your enrollment is processed smoothly by filling out the Dental Select Employee Enrollment Form online today.