2024 Enrollment Form

All premium payments are required  to be made via a recurring credit/debit card payment. Please complete the attached credit/debit card authorization form below and return either via fax (404-633-3943) or email to christy@gadental.org.

Credit Card Payment Authorization Form

2024 Benefits at a Glance

POS 1000
POS 3000
POS HDHP

Anthem Blue Cross vision members have access to one of the nation’s largest vision networks. Blue View Vision is the only vision plan that gives members the ability to use their in-network benefits at 1-800 CONTACTS, or choose a private practice eye doctor, or go in store to LensCrafters®, Sears OpticalSM, Target Optical®, JCPenney® Optical and most Pearle Vision® locations.

GDA 2024 Vision Benefit Summary

Included in your health insurance plan is a $10,000 term life benefit. Please click on the button(s) below to learn more about your life benefit and how to assign your beneficiaries.

Life Insurance Benefits Summary
Life Insurance Beneficiary Designation Form

2024 FAQ Document

To view your prescription drug formulary, please click the button below.
Anthem Pharmacy Information
After viewing the link above, select one of the following options for your chosen plan. 

POS 1000: Essential Formulary
POS 3000: Essential Formulary
POS HDHP: National 4-Tier Formulary

Members not currently enrolled should use "Use Member ID for Basic Search" option. In the box, enter "XKT" and click Continue.

Find a Provider

2024 Health Plan Notices and CHIP Notice
2024 Surprise Billing Notice

Summary Plan Description