Printable Enrollment Form
Use this form to enroll in the dental plan, add or drop dependents, or waive coverage. Just print the form, fill it out, and submit the completed form to your benefits administrator.

Printable Dental Claim Form
Just complete the printed form and fax it to 402-467-7336 or mail it to Ameritas Life Insurance Corp, Group Claims, PO Box 82520, Lincoln NE 68501.

Printable HIPAA Form 
Use this form to authorize the release of your protected health information.