PASR Dental and Vision Enrollment Forms

 

CLICK HERE to watch the most recent benefit presentation.  — 7/10/24 Please note we had some technical issues in the beginning with audio. If you have any questions, please contact the office by phone or email.

 

For policy coverage, please download the Dental and Vision Benefit Summary: HERE

 

To download/print forms, please click on the links below.

Dental and Vision insurance enrollment form: CLICK HERE

Monthly withdrawal form (Dental insurance only): CLICK HERE

 

Additional Dental and Vision Insurance Resources and Claim Forms: CLICK HERE

 

Please note the following:

  • We must receive the completed application and payment before the 20th of any month for your coverage to begin the 1st of the following month.
  • Vision must be paid in full
  • Dental and Vision insurance are for PAID PASR members and their eligible dependents. PASR routinely checks membership records to ensure compliance. Either you or your spouse must be a PAID member of PASR to enroll or renew your insurance coverage. Premiums are NOT refundable if canceled due to non-payment of membership dues.
    • Not a member? Want to join? CLICK HERE for how to join.