Section: Human Resources
Subject: Dental Insurance Enrollment
Approved by: Harvey L. Massey
Effective Date: 10 September 1990
Last Reviewed Date: 10 September 1990
Policy Owner: Director of Human Resources
Policy #
The Hartford Insurance Group is the designated insurance carrier for the dental insurance coverage.
The boxes for Dental are the only boxes needed to be marked for the selection for coverage. The “Designation of Beneficiary” on the reverse needs to be completed. The card must be signed and dated on the back side for acceptance of coverage.
Any employee not wanting dental insurance coverage for him/herself or their dependents, will need to sign the “Declining Dental Coverage” form.