Get the free CSEA DENTAL CLAIM FORM - Harrison High School - harrisoncsd

HARRISON SEA BENEFITS FUND c/o Insurance Programmers, Inc. PO BOX 5817 Wallingford, CT 064927616 Tel: 18008271703 Fax: 12032848656 DENTAL CLAIM FORM 1. Employees Name 4. Employees Mailing Address

How to fill out csea dental claim form

How to fill out csea dental claim form:

1. Obtain the csea dental claim form from your insurance provider or download it from their website.
2. Fill in your personal information, including your name, address, phone number, and policy number.
3. Provide details about the dental procedure or treatment you received, including the date of service and the name of the dentist or dental clinic.
4. Indicate the total cost of the procedure and any out-of-pocket expenses you incurred.
5. Attach any necessary supporting documentation, such as itemized receipts or invoices, to substantiate your claim.
6. Review the completed form for accuracy and make sure all required sections are filled out.
7. Sign and date the form to certify that the information provided is true and accurate.
8. Submit the completed csea dental claim form to your insurance provider according to their specified instructions.

Who needs csea dental claim form:

1. Individuals who are covered by the CSEA (Civil Service Employees Association) dental insurance plan and have received dental treatment or services.
2. Anyone who wants to seek reimbursement for dental expenses covered under their CSEA dental insurance plan.
3. Policyholders who want to file a claim for dental procedures or treatments that are eligible for coverage under their CSEA dental insurance plan.

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What is csea dental claim form?

The CSEA dental claim form is a form used to submit dental expenses for reimbursement from the Civil Service Employees Association.

Who is required to file csea dental claim form?

Any member of the Civil Service Employees Association who has incurred dental expenses and wishes to be reimbursed must file the CSEA dental claim form.

How to fill out csea dental claim form?

To fill out the CSEA dental claim form, one must accurately provide their personal information, details of the dental service received, and attach any necessary supporting documents such as receipts or invoices.

What is the purpose of csea dental claim form?

The purpose of the CSEA dental claim form is to request reimbursement for dental expenses incurred by members of the Civil Service Employees Association.

What information must be reported on csea dental claim form?

The CSEA dental claim form must include personal information, details of the dental service received, the cost of the service, and any supporting documents such as receipts or invoices.