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Colorado Employer Benefit Trust Dental Benefit Plan Revised: July 1, 2012, Approved by the Trust: July 10, 2012, SUMMARY PLAN DESCRIPTION REFUNDED DENTAL PLAN FOR COLORADO EMPLOYER BENEFIT TRUST EFFECTIVE
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How to fill out cebt dental 7112
How to fill out CEBT Dental 7112:
01
Start by gathering the necessary information, such as the patient's personal details, insurance information, and dental treatment required.
02
Begin filling out the form by entering the patient's full name, date of birth, and contact information in the designated fields.
03
Provide the patient's insurance information, including the policy number, group number, and any other relevant details.
04
Specify the dental treatment required by selecting the appropriate codes or descriptions for the procedures performed.
05
Indicate the date of service and the provider's information.
06
Ensure that all sections of the form are completed accurately and legibly.
07
Review the form to make sure all information is correct and nothing is missing.
08
Sign and date the form, indicating your role or relationship to the patient if necessary.
Who needs CEBT Dental 7112:
01
Individuals who have dental insurance through CEBT (Colorado Employee Benefit Trust) may need to fill out the CEBT Dental 7112 form.
02
This form is typically required for individuals seeking dental treatment and reimbursement through their CEBT dental insurance.
03
It is important to check with CEBT or your dental provider to confirm if the CEBT Dental 7112 form is necessary for your specific situation and treatment.
Remember, it is always best to consult your dental insurance provider or dental office for specific instructions and guidance on filling out the CEBT Dental 7112 form.
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