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HSA Dental ADDRESS CHANGE/CLOSED LOCATION/ADDITIONAL LOCATION FORM Note: Changes will impact all lines of business for which you are contracted. Provider Name: Degree:DMDorDDS (circle one)HSA Provider

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How to fill out hmsa dental

01

To fill out the HMSA Dental form, follow these steps:

02

Start by entering your personal information, including your name, address, and contact details.

03

Provide your HMSA membership information, such as your member ID and group number.

04

Indicate the effective date and any changes to your coverage.

05

Fill out the dental services section, providing details of the procedures you received or are requesting.

06

Specify the provider information, including their name, address, and National Provider Identifier (NPI) if available.

07

Provide any additional supporting documentation required.

08

Sign and date the form before submitting it to HMSA for processing.

Who needs hmsa dental?

01

Anyone who is an HMSA member and requires dental coverage can benefit from HMSA Dental.

02

This includes individuals and families who want access to a network of dental providers and insurance coverage for various dental services.

03

Employers may also offer HMSA Dental as part of their employee benefits package, providing dental insurance to their staff.

04

HMSA Dental is suitable for anyone who values oral health and wants financial protection and access to quality dental care.

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What is hmsa dental?

HMSA dental is a dental insurance plan provided by the Hawaii Medical Service Association.

Who is required to file hmsa dental?

Employers who offer HMSA dental as part of their benefits package are required to file.

How to fill out hmsa dental?

Employers can fill out HMSA dental forms online or by contacting HMSA directly for assistance.

What is the purpose of hmsa dental?

The purpose of HMSA dental is to provide dental insurance coverage to individuals and families.

What information must be reported on hmsa dental?

Employers must report employee enrollment information, coverage details, and premium payments.

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