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
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.
Dependent Spouse Information
Dependent Child 1 Information
Dependent Child 2 Information
Dependent Child 3 Information
Dependent Child 4 Information
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.
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.