Group Administrators

Why Securian Dental?
Administrator Sign In Product Information
Benefits Information
Q & A
Enrollment Reporting
Forms and Literature
Oral Health Resources
Dental Industry News

Forms and Literature

For your convenience, Securian Dental provides web site access to forms needed by group administrators below. Check back in the future as we add additional forms, brochures, applications and more.

The following documents can only be viewed by using Acrobat® Reader® software, which can be downloaded free of charge from www.adobe.com.

 1.  Securian Dental At A Glance

 2.  Disabled Dependent Application

 3.  Membership Enrollment Form

• For California Only
• For DC Only
• For Louisiana Only
• For Maryland Only
• For VT, ME, NH Only

 4.  Membership Enrollment Form - Spanish 

 5.  Membership Maintenance Form

• For Maryland Only
• For VT, ME, NH Only

 6.  What Is A Dental Plan? Q & A

 7.  Automated Clearinghouse (ACH) Authorization Agreement

 8.  Administrative Services Only Capabilities Sheet

 9.  Group Enrollment Checklist (VT, ME, NH)

10.  International Dental Emergency Program Brochure 

11.  Expatriate Dental Program Brochure

12.  International Dentist Listing 

13.  International Dental Program Claim Form with Instructions

14.  Exclusions and Limitations

15.  Online Enrollment User Request Form

16.  Online Enrollment Highlights

17.  Billing Reports Online User Request Form

18.  Billing Reports Online Change Request Form

19.  Group Premium Billing Schedule

20.  Reference Manual for Group Administrators - all states except VT, ME, NH

21.  Reference Manual for Group Administrators — VT, ME, NH

To view the Forms and Literature on this page, simply click on the articles.

To download an article straight to your computer, right-click and select "Save Target As."

Mac users: Option-click and select "Save Target As" to download the article to your computer.