209-478-4808

800-350-3989

New Group Enrollment Forms:

* Employer has the option to either fill out an Employee Roster Enrollment Form or an official Employee Group Dental & Vision Enrollment Form for each employee.  Both forms of enrollment are not required.


All group dental and vision applications may be faxed or emailed to Cypress Ancillary Benefits.  Initial premium check payable to “Cypress Ancillary Benefits” is required to be mailed in before processing of a group enrollment can take place.


Appointment Forms for Agents:

Submit all above items with a copy of your current insurance license.

Mail to:

Cypress Ancillary Benefits
7510 Shoreline Drive, Suite A-1
Stockton, CA 95219


Appointment Forms for Agencies:

Submit all above items with a copy of your current agency insurance license and a copy of a current agent license.

Mail to:

Cypress Ancillary Benefits
7510 Shoreline Drive, Suite A-1
Stockton, CA 95219