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Help and Resources

Downloadable Forms



Dental Deductible Carry-Over Credit Report for NY and PA (2576)

Dental Service Report (Claim Form) for NY and PA (1248)

Employee Dental Application for Enrollment or Change for PA (8646B)

Rayant Dental Discount Plan for NY/PA (2764)

Transmittal of Deletions form for NY and PA (2933)

Application for a Small Employer Dental Benefits Policy for PA (8758PA)

Application for a Small Employer Dental Benefits Policy for NY (8923NY)

Application for Enrollment or Change (4518)

Group Application for 51+ Employees NY/PA (5887)
FAQs

Do you have questions about affordable dental programs, claims, specialty care?

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Broker Online Services

Quick and easy access to the important information you need to service and manage your clients’ dental health plans.

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In New York, products are underwritten by Rayant Insurance Company of New York. In Pennsylvania, products are underwritten by Rayant Insurance Company of Pennsylvania.
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