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Customer Service

877-605-3229 Medical
888-374-8906 Dental
888-361-1610 Pharmacy

Marketing

888-374-8910

Employer Online Services

877-277-7075

Samples & Forms

Samples

• Dental Explanation of Benefits (EOB) (PDF)
• Medical Explanation of Benefits (EOB) (PDF)

Forms

Declination

• Declination of Dental (PDF)
• Declination of Medical (PDF)

Enrollment

• Medical & Dental Enrollment (PDF)
• Medical Only Enrollment (PDF)
• Dental Only Enrollment (PDF)
• Health Statement for groups 2-9 (PDF)
• Health Statement for groups 10-50 (PDF)
• Affidavit of Domestic Partnership for qualified plans (PDF)

Privacy

• Authorize ODS to use/disclose information about a member (PDF)  - Instructions

Other

• Request for Information
• Request for Printed Materials

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Medical insurance products provided by ODS Health Plan, Inc. Dental insurance products provided by Delta Dental Insurance Company and administered by ODS.