Federal DentalBlue Application

 

By completing the following process, you will be submitting an enrollment form for membership in Federal DentalBlue. At any time prior to electronically signing the enrollment form and pressing the submit button, you may exit this process. If you exit the process before electronically signing and submitting the enrollment form, you will need to restart the process to enroll on-line.

Upon completing the on-line enrollment process (by signing and submitting the enrollment form electronically), you will be prompted to view and print a hard copy of your completed enrollment form.  Once the enrollment process is complete, you will receive a confirmation number for tracking purposes.

By clicking "I AGREE" below, you signify your understanding and acceptance of the terms in the "Legal Disclaimer" and the "Privacy Statement" available for review by selecting the appropriate tabs below.  Accepting these terms does not obligate you to complete or submit your application for insurance.  If you do not understand and accept the terms of the Legal Disclaimer and Privacy Statement, you will not be able to continue with this online application process.

                                  Submit          I Disagree

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