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Connection Dental Plus Online Enrollment

Thank you for your interest in Connection Dental Plus. You can enroll online by completing the following information. If you need assistance with enrollment, please call us at 800.793.9335 Monday-Friday from 7 a.m. to 7 p.m. Central Time.

All fields are required unless marked as optional.

Current or Former Federal Employee, Survivor Annuitant, Overage Dependent of parents' FEDVIP Plan

This information is for enrollment purposes only. To protect your privacy, Connection Dental Plus will issue you a unique Dental ID number for benefit purposes.
(xxx-xxx-xxxx for U.S. numbers)

Physical Address

Please enter a 5-digit Zip code.

Mailing Address

Please enter a 5-digit Zip code.

Employment Information


Please select coverage option and enter information for your spouse or dependent children, as applicable. Connection Dental Plus eligible dependents are your legally married spouse and each unmarried child who is under age 26. Eligible dependents can enroll even if their parent (who is a current or former federal employee, or an annuitant) is not a GEHA member.

Dependent Spouse Information

Dependent Child 1 Information

Dependent Child 2 Information

Dependent Child 3 Information

Dependent Child 4 Information

Additional Dependents

FEHB or Additional Plan Information

Connection Dental Plus is a supplemental dental plan and will pay last after other coverage. Please provide the name of your current FEHB plan and any other coverage information (if applicable). If you have waived FEHB coverage, please enter WAIVED in this field. If you are a former Federal Employee no longer eligible for FEHB, please enter FORMER in this field.

This information can be found on your FEHB plan ID card or the front of the plan brochure.
(xxx-xxx-xxxx for U.S. numbers)

Payment Options

Please select how you will pay for your Connection Dental Plus coverage. After reading and accepting the terms and conditions below, please press Submit to send us your application. Please allow us one to two weeks to process your application and mail your ID cards. Your Connection Dental Plus coverage will not begin until the first of the month following receipt of your premium payment.

Monthly Premium: To view the current premiums, visit

Your coverage will be effective the first of the month following receipt of your completed application and premium payment. If you are requesting a later effective date of coverage, what month do you want coverage to begin?

Agree to Terms