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Dependent Enrollment Form Toll Free Phone: 800-999-9789 Toll Free Fax: 888-998-8704 D e n ta l S e LE c t. com Additional Dependent Enrollment PLEASE PRINT (This form must be submitted along with
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What is dependent enrollment form?
Dependent enrollment form is a document used to add eligible dependents to a healthcare plan or insurance policy.
Who is required to file dependent enrollment form?
Any individual who wishes to add their eligible dependents to their healthcare plan or insurance policy is required to file a dependent enrollment form.
How to fill out dependent enrollment form?
To fill out a dependent enrollment form, individuals must provide information about their eligible dependents such as name, date of birth, and relationship to the primary policyholder.
What is the purpose of dependent enrollment form?
The purpose of dependent enrollment form is to ensure that eligible dependents are added to the healthcare plan or insurance policy of the primary policyholder.
What information must be reported on dependent enrollment form?
Information such as dependent's name, date of birth, and relationship to the primary policyholder must be reported on the dependent enrollment form.
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