Get the free BSP1172b FederalEmployeeDental15 - Hanscom Federal Credit Union - hfcu
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Massachusetts Federal Employees Dental Plan ENROLLMENT FORM Delta Dental of Massachusetts P.O. Box 9695 Boston, Massachusetts, 021149695 Customer Service: Corporate Office: Fax: (617 8861234 617 8861000
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How to fill out bsp1172b federalemployeedental15 - hanscom
How to fill out bsp1172b federalemployeedental15 - hanscom?
01
Start by entering your personal information such as your full name, address, and contact details in the designated fields.
02
Provide your email address and select your marital status from the options given.
03
Indicate the name of your employing agency or organization and enter your social security number.
04
Next, provide information about your dental carrier, including the carrier's name, address, and contact details.
05
Specify the type of coverage you are applying for by selecting the appropriate box. You can choose from Self Only, Self Plus One, or Self and Family.
06
If you have any other dental coverage, mark the relevant box and provide the details of that coverage.
07
If you are currently enrolled in a dental plan, indicate the enrollment code, carrier name, and the type of coverage you hold.
08
Provide any dependents' information if applicable, including their full names, social security numbers, and date of birth.
09
Sign and date the form to certify the accuracy of the information provided.
Who needs bsp1172b federalemployeedental15 - hanscom?
01
Federal employees who are eligible for the dental benefits.
02
Individuals who want to enroll in the federal employee dental program offered by Hanscom Air Force Base.
03
Federal employees who wish to make changes to their current dental coverage or enrollees who need to re-enroll for the next eligibility period.
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What is bsp1172b federalemployeedental15 - hanscom?
bsp1172b federalemployeedental15 - hanscom is a form used for federal employees to enroll in dental insurance at the Hanscom Air Force Base.
Who is required to file bsp1172b federalemployeedental15 - hanscom?
Federal employees who wish to enroll in dental insurance at the Hanscom Air Force Base are required to file bsp1172b federalemployeedental15 - hanscom.
How to fill out bsp1172b federalemployeedental15 - hanscom?
To fill out bsp1172b federalemployeedental15 - hanscom, individuals need to provide their personal information, choose a dental insurance plan, and submit the form to the appropriate office at Hanscom Air Force Base.
What is the purpose of bsp1172b federalemployeedental15 - hanscom?
The purpose of bsp1172b federalemployeedental15 - hanscom is to allow federal employees to enroll in dental insurance coverage at the Hanscom Air Force Base.
What information must be reported on bsp1172b federalemployeedental15 - hanscom?
Information such as personal details, choice of dental insurance plan, and any relevant dependents must be reported on bsp1172b federalemployeedental15 - hanscom.
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