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Enrollment Kit - Ameritas (Dental)

This checklist is provided as a guide. The carrier may require additional items and documentation. Please refer to the carrier's underwriting guidelines for a complete list of requirements. Please use the latest version of forms.
Our goal is to process your new group enrollment easily and efficiently in order to provide you and your client with a quick approval.  The following list outlines Ameritas’ case submission requirements.
Selling Group Dental from the Brochure:

Submitting a Group with “Takeover” Benefits:
  • All of the above plus a copy of the prior carrier’s benefits.
  • Copy of the takeover quote, if quoted.
Documentation Requirements:
  • Group Application** (signed by Agent and Officer of group).
  • Group Plan Selection Form**
  • Employee Enr​ollment Form​ completed for each enrollee.
  • Waiver of coverage on back of enrollment information signed by employee when declining coverage
  • A check for the first month premium.
  • A copy of the prior carrier’s benefits* (required for all plans).
  • A copy of the quote, if applicable.​
* Only required when selling “takeover.”
** When submitting new business online, simply retain signed copies of the Master Application and Group Plan Selection Form for your records​.

Licensing: ​Broker appointment must be completed via t​​his linkThe group will not be approved until licensing is received.

After approval, prior carrier termination letter must be submitted by the employer or broker.​
For other useful or older documents, please refer to the Forms database.