Professional Benefit Administrators

PROFESSIONAL BENEFIT
ADMINISTRATORS

1130 Hurricane Shoals Road NE
Suite 2300
Lawrenceville, GA 30043

Phone: (770) 963-3939
(800) 578-2082
Fax: (770) 963-6126
(888) 264-6975

ENROLL NOW!

Click and print the two forms below, and mail or fax to:

Enrollment Forms

Enrollment Form
Method of Payment

Agent Forms
B4 Form
PDA2 Form
B4BD Form
1199A Form

AFLAC Agent Forms
B4 DED Federal
B4 Split Allotment

Dental Plan Carriers
-for-
Tennessee

(Click on Name for More Information on Carrier)

Diamond 1500

Elite 75 Schedule

Humana CS-150
(Includes Specialty Benefits)