The Dental section provides a comprehensive list of AmeriHealth New Jersey dental forms for you to access. Please contact your AmeriHealth New Jersey broker representative for more information regarding United Concordia Dental plans and rates.
Forms are in PDF format.
| Option | Last Updated |
|---|---|
| Pediatric Dental Attestation Form | 2014-05 |
| United Concordia Application for Group Dental Coverage | 2014-05 |
| United Concordia Dental Claim Form | 2013-05 |
| United Concordia Dental Claim Form Instructions | 2013-05 |
| United Concordia Dental Enrollment Form | 2005-07 |
| United Concordia Dental Large Group Application | 2005-07 |
| United Concordia Dental Rate Card | 2013-12 |
| United Concordia Dental Small Group Application | 2005-07 |
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Coverage issued by AmeriHealth HMO, Inc. and/or AmeriHealth Insurance Company of New Jersey.