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HDS Use Only ENROLLMENT FORM OAHU: PHONE: 529-9230 FAX: 529-9207 A. Group / Contact Information Group Name Contact Name B. Subscriber / Contact Phone # Effective Date — ext This section must be

How to fill out hds enrollment form

How to fill out hds enrollment form:

1. Start by obtaining a copy of the hds enrollment form from the appropriate source.
2. Carefully read through the instructions provided on the form to ensure that you understand the requirements and any specific information that needs to be included.
3. Begin by providing your personal information, such as your name, date of birth, and contact details.
4. If applicable, provide information about your current employer or educational institution, including the name, address, and contact information.
5. Fill in the required sections regarding your preferred hds plan and coverage options.
6. If you have any dependents that need to be included on the enrollment form, provide their information as well, including their names, dates of birth, and relationship to you.
7. Ensure that you provide any necessary documentation or supporting evidence, such as identification cards or proof of eligibility, as specified on the form.
8. Review your completed enrollment form carefully to make sure that all information is accurate and up to date.
9. Sign and date the form in the designated areas to verify your understanding and agreement with the provided information.
10. Submit the completed hds enrollment form as instructed, whether it is via mail, email, or through an online portal.

Who needs hds enrollment form:

1. Individuals who are seeking healthcare coverage through hds, such as health insurance plans or prescription drug plans, will need to fill out an hds enrollment form.
2. Employees who are eligible for hds coverage through their employer will also need to complete the enrollment form to indicate their choices and provide necessary information.
3. Students or individuals enrolling in an educational institution that offers hds coverage may be required to fill out the enrollment form to access healthcare benefits.
4. Dependents, such as spouses or children, who are eligible for coverage under an hds plan will also need to be included on the enrollment form.

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What is hds enrollment form?

The HDS enrollment form is a document used to enroll in a health and dental insurance plan offered by Hawaii Dental Service (HDS).

Who is required to file hds enrollment form?

Any individual or employee who wishes to enroll in a health and dental insurance plan offered by HDS is required to file the HDS enrollment form.

How to fill out hds enrollment form?

To fill out the HDS enrollment form, you need to provide personal information, contact details, and select the desired health and dental insurance plan options.

What is the purpose of hds enrollment form?

The purpose of the HDS enrollment form is to ensure individuals have access to health and dental insurance coverage through HDS.

What information must be reported on hds enrollment form?

The HDS enrollment form requires information such as name, address, contact details, employment status, and desired insurance plan selections.