BEST Health Plans Forms

Please make a selection from the menu below:

1. CA Dental HMO
2. CA Dental PPO/Indemnity
3. TX Dental HMO
4. TX Dental PPO/Indemnity
5. FL Prepaid Dental
6. FL Dental PPO/Indemnity
7. In-Network Only Dental

CA DENTAL HMO

1. CA Employer Group Application (PDF)
2. CA DHMO Enrollment and Change of Status Form (PDF)

CA DENTAL PPO/INDEMNITY

1. CA Employer Group Dental PPO Application (Word)
2. CA Employer Group Dental Indemnity Application (Word)
3. Dental PPO/Indemnity Enrollment Form English (Word)
4. Dental PPO/Indemnity Enrolmlent Form Spanish (Word)
5. Dental PPO/Indemnity Quick Enroll (Excel)
6. Termination of Coverage Request (Word)

TX DENTAL HMO

1. TX Employer Group Application (Word)
2. TX DHMO Enrollment and Change of Status Form (PDF)

TX DENTAL PPO/INDEMNITY

1. TX Employer Group Dental PPO Application (Word)
2. TX Employer Group Dental Indemnity Application (Word)
3. Dental PPO/Indemnity Enrollment Form English (Word)
4. Dental PPO/Indemnity Enrolmlent Form Spanish (Word)
5. Dental PPO/Indemnity Quick Enroll (Excel)
6. Termination of Coverage Request (Word)

FL PREPAID DENTAL

1. FL Employer Group Application (Word)
2. FL Prepaid Dental Enrollment and Change of Status Form (Word)

FL DENTAL PPO/INDEMNITY

1. FL Employer Group Dental PPO Application (Word)
2. FL Employer Group Dental Indemnity Application (Word)
3. Dental PPO/Indemnity Enrollment Form English (Word)
4. Dental PPO/Indemnity Enrolmlent Form Spanish (Word)
5. Dental PPO/Indemnity Quick Enroll (Excel)
6. Termination of Coverage Request (Word)

IN-NETWORK ONLY DENTAL

1. CO INO Employer Group Application (Word)
2. INO Employer Group Application for AZ, IN, MI, NV & UT (Word)
3. CO INO Enrollment and Change of Status Form (Word)
4. INO Enrollment and Change of Status Form for AZ, IN, MI, NV & UT (Word)
5. Out of Network Dental Claim Form (PDF)