Thank You for Your Business!

Welcome to Employer Group Enroll! We know you have a choice for your dental insurance and we thank you for choosing SecureCare Dental!

When you use our secure Employer Group Enroll page, we process your new group even faster, allowing your employees to schedule dentist appointments sooner!

You may submit all of your information now or submit part now and the rest at a later time. However, we will only issue your group ID number indicating coverage is in effect when we have all the required materials completed.

An * means that field is a required one that has to be filled in with the requested information.
To submit your new group enrollments and plan materials, please follow these simple steps:
*Your First Name:
*Your last Name:
*Your Email Address:
*Name Of Company Enrolling:
*Group HQ State:	Select a StateArizonaNevada
*Broker Name:
*Broker Email Address:
1. ATTACH NEW GROUP ENROLLMENT MATERIALS
To enroll your new group, please include the following items. Check the box(s) next to the item(s) you are attaching at this time. You will receive an immediate email receipt indicating receipt of the items submitted.
When you complete this section, please continue to number 2 where you may submit your employee enrollments.
Employer Master Group Application Master Application must be complete in order to process and issue your policy and ID cards. Employer’s most recent state and quarterly unemployment tax report If the wage & tax is not available, please submit the most recent payroll run. Employee wages do not need to be listed. This is to verify full-time employment status only. (Employer must be in business for at least 12 months. Groups of two must not be husband/wife only groups.) Copy of Employer binder check for 1st month’s premium and admin fee (We will begin processing your group with this copy of your binder check; however, we do need the original check before we can provide a group ID number.) Prior Coverage Credit Submit a copy of the present carrier’s summary of benefits or a complete policy. If current plan is a prepaid (HMO) plan, please submit the current schedule of copays. Present carrier’s last monthly premium bill Prior to your group’s effective date with SecureCare Dental. Include each employee’s effective date of coverage under the prior plan to receive complete take-over credit. Census Enrollment If you are submitting employees by census enrollment rather than online enrollment, then attach the employee census here. Please include proof of full-time student status for dependents ages 19 through 24 years old. Original SecureCare Dental Quote To ensure that your group’s plan selections are accurately reflected in our system, please attach a copy of the dental benefits quote you received from SecureCare Dental.
Comments/Notes
Please use this section to communicate information to us that you feel is pertinent to the enrollment of this new group.
Attach the Enrollment Materials Checked Above.
You may use this section to attach documents checked above. Documents attached will be sent with your email when you click "Submit". Attachments may only have the file extensions: .txt, .jpg, .bmp, .tif or pdf.
Add Attachments
Click 'Submit' to send us the attached new group materials.

2. EMPLOYEE ENROLLMENTS/WAIVERS

Please click here to submit your group’s employees. All employees must be submitted before SecureCare Dental can cover them and verify eligibility. With each employee submitted you will receive an immediate email confirming the submission and listing the employee information you entered.

3. FINISH NEW GROUP SUBMISSION

You may return at any time and submit additional enrollments and plan materials. However, as a reminder, all employee enrollments and plan materials must be submitted and complete before we are able to enter your group for coverage.

If you have submitted your new group’s enrollment materials and employee Enrollments, then you may close this New Group Enroll session at this time. Was this page helpful to you? Please let us know your feedback here. How can we improve this page for you?

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