Online Application | Camco Benefit Services | Vision and Dental Insurance

Policy will be effective the first day of any given month. Mail or Fax completed forms to:

Camco Benefit Services

PO Box 5667

Lacey, WA 98509

FAX: 1-360-438-6256

Online Application - Tell Us About You

New Application

PLEASE NOTE: You should complete and submit this online enrollment request form only once.

Change of Information Requests
If you have already submitted an enrollment request, but need to change your enrollment information (e.g. adding or deleting dependents, changing your address, etc.), A CHANGE OF INFORMATION REQUEST must be submitted in writing to Camco Benefit Services. You can email Camco Benefit Services at info@camcobenefits.com, or you can click here to choose and download an application form. Mail or fax the completed form to:

Camco Benefit Services
PO Box 5667
Lacey, WA 98509
FAX: 1-360-438-6256

*Select A Dental Plan

Standard High Dental Plan
Learn More Standard Low Dental Plan
Learn More

Standard Orthodontics Plan
Learn More N/A

*Select A Vision Plan

VSP Vision Plan
Learn More EyeMed Vision Plan
Learn More

N/A

*Plan Effective Date
(The first of any month)

Please enter an effective date.

*First Name

Please enter a first name.

*Last Name

Please enter a last name.

Middle Initial

*Date of Hire (approx.)

Please enter a hire date.

Union Local Number
(AFGE members only)

select

What's this? American Federation of Government Employees Explanation

*Gender

Female Male

*Employment Status

Active Retired

*Date of Birth

Please enter a date of birth.

*Social Security Number

*Home Address
(include apt #)

Please enter an address.

*City

Please enter a city.

*State

select

NOTE: The Standard Low Dental Plan is not offered in Utah. If you live in Utah and have picked the Standard Low Dental Plan, you will be enrolled in the Standard High Dental Plan.

*Zip

*Email

*Confirm Email

*Daytime Phone

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