dental plan information

personalized services

Online — 24/7 access to dental claims, benefit information, and much more through our online self-service center, My Blueprint.
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forms

Dental Claim Form (PDF)
Accident Form for Dental Injury (PDF)
Individual and Family Dental Change Form (PDF)
Group Dental Application and Change Form (PDF) — To make a change, please complete this form and return it to your group administrator.

dental providers

Arkansas Dental Provider Network
National Dental Provider Network

dental plan information

let us help you

If you would like personal information on your family’s eligibility, benefits or claim status, please call Customer Service at 1-888-223-4999. Operating hours are Monday – Friday from 7 a.m. - 5 p.m. CST.

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