United Concordia small group enrollment forms for 2017


To enroll you on United Concordia they will require the following:

  • The rate sheet with the benefit plan circled and the sheet signed at the bottom by the business manager or owner
  • The completed employee applications for each employee enrolling. The form needs to be complete with each dependent’s name, date of birth, etc.
  • A company check for the first month’s premium payable to United Concordia Companies Inc. or UCCI
  • A completed employer application form. Complete what you can and we’ll finish the rest together.

Download The New Group Enrollment Kit for 2017

You can fax everything to our secure fax at (888)-287-3186, and then mail the originals to:

Total Benefit Solutions, Inc.

427 E. Street Road

Feasterville, PA 19053

Download UCCI PA Rates and Benefits 2017

Download UCCI Group Application 2017

Download UCCI PA Employee Enrollment Form


As always please contact your Total Benefit Solutions, Inc account manager at (215)355-2121 if you have any questions or concerns about United Concordia Dental plans and enrollments.