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Dental Enrollment Forms - Local 641 - 2026/2027

Dental Authorization Form
Dental Authorization Form
Open Enrollment Notice 2026-2027
Open Enrollment Notice 2026-2027
Dental Application (Local 641)
Dental Application (Local 641)

A.F.S.C.M.E. LOCAL 641 HEALTH & WELFARE FUND DENTAL PLAN

Contact Person: Nancy Carvalho          ncarvalhodental@gmail.com

THERE IS A $15.00 ADMINISTRATIVE FEEFOR ALL NEW MEMBERS – IT WILL BE DEDUCTED FROM YOUR FIRST DENTAL DEDUCTION.

Newly hired employees must apply within 30 days of hire date or wait for next year’s Open Enrollment period.