RESOURCE CENTER

Installation Forms
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08.26.2011
United Concordia BOR letter (for former AIC broker)
Sample of Broker of Record letter to be used for existing UCCI clients. No other version will be acceptable. For use ONLY if group is not in IBC/AHNJ territory or written direct with UCCI; otherwise IBC/AHNJ BOR will takeover linked UCCI cases.
email download
08.26.2011
United Concordia BOR letter
Sample of Broker of Record letter to be used for existing UCCI clients. No other version will be acceptable. For use ONLY if group is not in IBC/AHNJ territory or written direct with UCCI; otherwise IBC/AHNJ BOR will takeover linked UCCI cases.
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02.20.2012
Application for Group Dental Insurance (PA)
Group application to be completed by PA employer for new business and renewal submission.
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08.18.2011
Application for Group DMO Dental Insurance (NJ)
Group application to be completed by NJ employer for new business or renewal submission for a DMO plan.
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08.18.2011
Application for Group FFS Dental Insurance (NJ)
Group application to be completed by NJ employer for new business or renewal submission for a FFS plan.
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08.18.2011
Dental Enrollment Form for DMO plan (NJ)
Form to be used for employee eligibility into a DMO plan; new business or otherwise. For NJ employer groups.
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08.18.2011
Dental Enrollment Form for FFS plan (NJ)
Form to be used for employee eligibility into a FFS plan; new business or otherwise. For NJ employer groups.
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08.18.2011
Dental Enrollment Form (PA)
Form to be used for employee eligibility; new business or otherwise. For PA employer groups.
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