May 12, 2021


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Benefits Connection applications for Highmark Blue Cross Blue Shield, Aetna, United Concordia Dental, Dominion Dental and Delta Dental and Vision Forms are available by clicking on the links below.

These forms may be printed (PDF files), completed and faxed to us at 302-654-8836. To protect your privacy we do not allow these applications to be completed online.

You may also call our office (302-654-8823) and will be happy to provide these forms to you.

Highmark BCBS Employee Enrollment/Waiver Form      

Highmark BCBS Change Form

Highmark BCBS Group Application  

Aetna Employee Enrollment/Change/Waiver Form  

Aetna Group Application    

Dental Connection Application

Vision Application for VSP Vision     

Chamber Membership Application