Benefits Connection Exchange

Enrollment Forms      

Benefits Connection applications for Highmark Blue Cross Blue Shield, Aetna, United Concordia Dental, Dominion Dental and Delta Dental, Vision and HSA Forms are available by clicking on the links below.

These forms may be printed (PDF files), completed forms can be faxed to
302-654-8836 or scanned & emailed to BenefitsConnection@AllenInsurance.com

You may also call our office (302-654-8823) and we will be happy to provide these forms to you.

HMBCBS Logo
Highmark BCBS Employee Enrollment/Change/Waiver Form 
     

Highmark BCBS Group Application  

AETNA Logo
Aetna Employee Enrollment/Change/Waiver Form
  

Aetna Group Enrollment Form      

UNIC Dental Logo United Concordia Enrollment Application     

Dominion Dental Logo Dominion Dental Enrollment Application


Delta NEW LOGO Delta Dental Enrollment Application

VSP Logo Vision Application for VSP Vision                  

 

 Chamber Membership Application

 

 

 

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 Toll Free: 800.486.1244
 Local: 302.654.8823

Insurance Products provided through
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 Broker since 1980
302-654-8823
Wilmington, DE 19801
Allen@AllenInsurance.com





 
 
 
 

 


  
 

 
 

 
 

 



      
           
   




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