Enrollment/Claim Forms

To enroll in the Direct Reimbursement Dental plan, please see your Human Resources department at work.

To obtain claim forms or information about a claim, please contact:
Gulf South Risk Services, Inc.
www.gulfsouthrisk.com
(800) 256-4776

Claims can be submitted to the following address:
Gulf South Risk Services, Inc.
P.O. Box 21537
Eagan, MN 55121
Payer ID #: 60389