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.
- Application for Group Coverage - Employer Application (DHMO).
- Census Enrollment Sheet.
- Employee Enrollment Forms – submit one enrollment form per enrollee.
- First month’s premium check made payable to “California Dental Network”.
- Prior Carrier Invoice and Prior Carrier Benefit Summary, if applicable.
- Copy of quote or copy of rates used to sell case.
- Broker Licensing: Agent Contract and copy of license (if applicable).
|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.