BlueCross BlueShield of Alabama

1-800-492-8872

(8 a.m. - 5 p.m. CST)

Alabama Federal DentalBlue Enrollment

Applicant
Dependent
Select Plan
Agreement
Authorization
Payment
Confirmation

Employee Information

This is our Service Benefit Plan Basic or Standard Option Enrollees Only.


Please complete all items on this application. Any information missing may delay processing your application.


To enroll in Alabama Federal DentalBlue you must reside in the service area of Blue Cross and Blue Shield of Alabama. If you enroll in the FEHB Basic Option, you will automatically be enrolled in Alabama Federal DentalBlue Basic Option. The same is true for Standard Option.


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