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.

• Eligibility
• Enrollment
• Plan Highlights
• Rates

Forms & Publications

• CIGNA Dental Plan Handbook
• Amendments to Dental Plan Handbook
• CIGNA Transition Information
• Retiree Dental Enrollment/Change Form (SFN 53504)
• Employer Verification of Insurance Coverage (SFN 53621)
• Retiree Authorization for Premium Deduction (SFN 50134)
• TFFR Payroll Deduction Authorization (SFN 19182)
• Verification of Alternate Retirement Plan (SFN 53863)
• Payroll Deduction Authorization (SFN-19182)
• CIGNA Dental HIPAA Privacy Notice
• CIGNA Dental ID Card
• How to Obtain Your CIGNA Member ID

Claim Filing

Dental Claims/Inquiries
P O Box 188037
Chattanooga, TN 37422-8037
1(800)244-6224

Policy Holder: North Dakota Public Employees Retirement System
Group Policy Number: 3328472