PASR Dental and Vision Enrollment Forms

CLICK HERE to watch the most recent benefit presentation. If you have any questions, don’t hesitate to get in touch with the office by phone or email.

For policy coverage, please download the Dental and Vision Benefit Summary: HERE

To download/print forms, please click on the links below.

Dental and Vision insurance enrollment form: CLICK HERE

Monthly withdrawal form (Dental insurance only): CLICK HERE

Additional Dental and Vision Insurance Resources and Claim Forms: CLICK HERE

Please note the following:

• We must receive the completed application and payment before the 20th of any month for your coverage to begin the 1st of the following month.
• Vision must be paid in full
• Dental and Vision insurance are for PAID PASR members and their eligible dependents. PASR routinely checks membership records to ensure compliance. Either you or your spouse must be a PAID member of PASR to enroll or renew your insurance coverage. Premiums are NOT refundable if canceled due to non-payment of membership dues.
  • Not a member? Want to join? CLICK HERE for how to join.