About American General

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Please Contact Customer Service

Your Customer Service Representative will provide you with all the information you need for your account.
P - (877) 296.3800
F - (310) 391.6534

Employer Flyer

For brokers to give to their clients.

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Employee Application

Please use the employee enrollment form to add a new employee to your plan. This form is also used when an employee is adding on a family member or changing their coverage. You can submit a new enrollment via fax or email.
FAX: (310) 391.6534 or Email
customerservice@employeechoicedental.com.

American General Claim Form

The American General Claim Form is required when an employee goes to an out of network dentist. When submitting the claim form, please make sure to send it directly to the American General Processing Center.

Cobra

Do you have an employee that is leaving the company and wants to keep their coverage? If so, please submit this application to us and we will extend the employee’s coverage per federal guidelines. Please note that the employee will stay on your bill, so you are responsible for billing and collecting premium for that person directly.

Cal Cobra (California Only)

This form is used for employees who wish to continue their group coverage and have either exhausted all applicable COBRA benefits or who work for firms with less than 20 employees. When filling out this form the employee must make sure to sign and date as well as send the first six months payment. Once this form has been processed, a new account is created for the former employee and we bill them directly at their home address. Kelsey National Corporation charges a 10% fee for the administration of CAL-COBRA accounts.

Domestic Partner Form

Form for Domestic Partner Certification.

Privacy Policy

American General Privacy Policy Statement.

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