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Forms and Literature

Forms and Literature

For your convenience, Securian Dental provides web site access to forms needed by individuals 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. Claim Form
   
   
2. Disabled Dependent/Michelle's Law Application 
   
   
3. What Is A Dental Plan? Q & A
   
   
4. HIPAA Authorization Forms
   
• All States Except Oklahoma
  
  
• Oklahoma
  
  
5. International Dental Emergency Program Brochure 
   
   
6. International Expatriate Dental Program Brochure
   
   
7. International Emergency Dental Program FAQs
   
   
8. International Dentist Listing
   
   
9. International Emergency Dental and Expatriate Dental Program for Members
   
   
10. International Dentist Nomination Form
    
    

11. Top Five Group Policies in Maine

    • Voluntary 4 - 100/50/50/50 coinsurance, 50/150 deductible,
      1,500 annual maximum
    • Voluntary 1 - 100/50/50/50 coinsurance, 25/75 deductible,
      1,000 annual maximum
    • Voluntary 4 - 100/50/50/50 coinsurance, 50/150 deductible,
      1,000 annual maximum
    • Voluntary 1 - 100/50/50/50 coinsurance, 50/150 deductible,
      1,000 annual maximum
    • Voluntary 2 - 100/80/80/50 coinsurance, 50/150 deductible,
      1,000 annual maximum