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| Coverage level | Cost |
|---|---|
| Employee | $37.12 |
| Employee + One | $73.15 |
| Family | $112.98 |
Dental Enrollment Form
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If you are enrolling in dental for the first time or adding children under 3 years, be sure to download and complete the enrollment form.
Complete the following sections (Product Selection, Dependent and Other Insurance Information, Request for Coverage) and sign and date the form.
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