Dental Plan Option for
Lafayette College Students

UNITED CONCORDIA FLEX PPO DENTAL PLAN
2025-2026 Policy Year
Spring Enrollment Form

The enrollment deadline for coverage effective January 1, 2026 through August 31, 2026 has been extended to January 15, 2026. Enrollment will be processed after the deadline. Once processed, coverage will be effective back to January 1, 2026 though August 31, 2026.

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