Enrollment Forms





Agent Forms



Cancellation Forms



You can mail or fax forms to:
Professional Benefit Administrators
1000 Hurricane Shoals Road
Suite C 370
Lawrenceville, GA 30043
Phone: (770) 963-3939
Toll-free: (800) 578-2082
Fax: (770) 963-6126
Toll-free Fax: (888) 264-6975
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Dental Plans offered in Louisiana
Choose a carrier below for more information on benefits and costs.
Aetna Dental Access PPO
Careington Discounted Dental
Cigna Preferred Network Access
CignaPlus Savings
Diamond 1500
DINA
Elite 75
Humana PPO
Vital Savings by Aetna PPO
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