Connection Dental Plus Online Enrollment

    Thank you for your interest in Connection Dental Plus. You can enroll online by completing the following information. If you need assistance with enrollment, please call us at (800) 793-9335 Monday-Friday from 7 a.m. to 5:30 p.m. Central Time.

    *Indicates required information

    Current or Former Federal Employee or Survivor Annuitant







    Physical Address


    Employment Information




    Coverage

    Please select coverage option and enter information for your spouse or dependent children, as applicable. Connection Dental Plus eligible dependents are your legally married spouse and each unmarried child who is under age 26. Eligible dependents can be enrolled only if the federal employee or annuitant enrolls.




    FEHB or Additional Plan Information

    Connection Dental Plus is a supplemental dental plan and will pay last after other coverage. Please provide the name of your current FEHB and any other coverage information (if applicable). If you have waived FEHB coverage, please enter WAIVED in this field. If you are a former Federal Employee no longer eligible for FEHB, please enter FORMER in this field.







    Payment Options

    Please select how you will pay for your Connection Dental Plus coverage. After reading and accepting the terms and conditions below, please press Submit to send us your application. Please allow us one to two weeks to process your application and mail your ID cards. Your Connection Dental Plus coverage will not begin until the first of the month following receipt of your premium payment.


    Monthly Premium: To view the current premiums, click Connection Dental Plus Premium Pricing





    Agree to Terms


    If you have any questions or need assistance with this form, please call us at (800) 793-9335.