Member Forms
- ADA Claim Form
- Dental Preferred Provider Nomination Request Form
- Dependent Student Certification Form
- F-2649-Dental Care Infographic Web Flyer
- Generic Website Login Flyer
- Healthplex Clinical Criteria Master 2020 - Comprehensive or Limited Benefit Service Plans
- Healthplex Clinical Criteria Master 2020 - Essential Services Plans
- Medicare AOR (Appointment of Representative)
- Member Letter on COVID-19
- OIG Fraud Hotline Poster
- Subscriber Change Form