PASR Dental and Vision Enrollment Forms


CLICK HERE to watch the most recent benefit presentation.

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.