Securian Dental: Broker Forms and Literature

Forms and Literature

For your convenience, Securian Dental provides web site access to forms needed by brokers 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.

Company Information

Broker Appointment

Product Sheets

Quoting Tools

Apr 2010-Dec 2010 New Hampshire Voluntary and Contributory (Access) Rates

Apr 2010-Dec 2010 Maine Voluntary and Contributory (First Choice and Access) Rates

Jan 2010-Dec 2010 Vermont Voluntary and Contributory (Access) Rates

Web Access

Group Application and Billing

Member Enrollment and Maintenance

If you need Snapshots of Coverage to assist in enrollment, please contact SecurianConnect at 1-866-827-3318 or email securianconnect@securiandental.com.

COBRA Information

COBRA Premium Subsidy Recap
COBRA Election Form for groups with less than 20 full-time employees. (Please note: This form does not apply to groups based in AL, AK, AZ, DE, HI, ID, IN, MI, MT, PA, or VA as these states do not have laws that provide for continuation of coverage for groups of fewer than 20 employees.)

Brokers