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Washington Central Supervisory Union GROUP 50670 MAIL THIS FORM TO CBA BLUE P. O. BOX 9350 SO BURLINGTON VT 05407-9350 Phone 888 222-9206 STATEMENT OF CLAIM FOR GROUP DENTAL BENEFITS PART I - TO BE COMPLETED BY EMPLOYEE Relationship to Employee Patient Name Employee Name Participant ID Patient Birthdate Employee Birthdate Employee Mailing Address Yes No If Yes please Provide Dental Plan Name Group Number Name and Address of Carrier Is Patient Covered by Another Dental Plan If Yes Enter Brief...
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What is group 50670?
Group 50670 is a category or classification used for reporting purposes.
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Entities specified by the regulatory body are required to file group 50670.
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The purpose of group 50670 is to gather specific data for regulatory or compliance reasons.
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Group 50670 typically requires information related to finances, operations, or other relevant data.
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