Dental Plan Option for
Lafayette College Students

UNITED CONCORDIA FLEX PPO DENTAL PLAN
2024-2025 Policy Year
Annual Enrollment Form

The enrollment deadline for coverage effective September 1, 2024 through August 31, 2025 has been extended to October 15, 2024. This is the final fall deadline. No exceptions will be made. Enrollment will be processed after the deadline. Once processed, coverage will be effective September 1, 2024 though August 31, 2025.

TO CONTINUE THE ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW: