Voluntary Dental Plan

NOTE: The links in the following list will each open in a new window. Be sure to close each new window BEFORE selecting another link.

• Plan Highlights
• Summary Plan Description
• Rates

Forms & Publications

• Retiree Dental/Vision Insurance Enrollment/Change (SFN 53504)
• Employer Verification of Insurance Coverage (SFN 53621)
• Authorization for Premium Deduction (SFN 50134)
• TFFR Payroll Deduction Authorization (SFN 19182)
• Verification of Alternate Retirement Plan (SFN 53863)

Claim Filing

Dental Claims/Inquiries
P O Box 59238
Minneapolis, MN 55459
1(800)448-3815

Policy Holder: North Dakota Public Employees Retirement System
Group Number: 537482