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Dental Plan Option for
Lehigh University Students

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


The enrollment deadline for coverage effective Janaury 1, 2025 through August 31, 2025 is December 15, 2024

Enrollment will be processed AFTER the deadline. Once processed, coverage will be effective January 1, 2025.

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

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)