How to enroll: Golden West Dental & Vision

It is easy, all you need to complete is the following

If you can not open the files below get Acrobat Reader :


Group Master Application, completed and signed by an officer of the company.

High-Low Master App

Standard Master App

 
  • Employee Enrollment Cards. Be sure to have member complete name, Social Security #, dentist office selected (if applicable), and all dependents to be covered.

  • Binder check payable to "Golden West Dental & VIsion" equal to first month's premium.
 
  • Confirmation of plan design, rates sold, Golden West proposal, and effective date of plan.

Contact us with any questions:

Health Plans Online, Inc.
31194 La Baya Drive, Suite 201
Westlake Village, CA 91362
(888) 474-6627

Coverage can be effective the first day of any month. Do not cancel any inforce coverage until you have received written approval from the carrier. Since underwriting needs time to process your group, we suggest that enrollment forms are submitted two weeks prior to the requested effective date.