Superior Officers Council City of New York Police Department

Active Member Dental Benefit

Dentall

Forms

Co-Payment Listing (.pdf, 25kb)
 Change Dentist Form (.pdf, 278kb)
 Disenrollment Form (.pdf, 278kb)

Adobe Reader is required to view all forms. Download it here

www.adobe.com/products/acrobat/readstep2.html

Dentall is no longer accepting new subscribers.

Changing Dental Offices

To change dental offices, the member is required to fill out a change of dentist form linked above. This form must be completed and received by the SOC by the 12th of the month for a change in coverage the 1st of the following month.

Please contact the SOC for the most up to date listing of participating providers.

Disenrolling from Dentall

To disenroll from Dentall, the member is required to fill out the corresponding disenrollment form linked above. Disenrollment from Dentall is permanent.