Get the free Faculty Dental Claim Form - Suffolk County Community College - sunysuffolk

FA SCC Benefit Fund 4k IMPORTANT NOTICE PRE-DETERMINATION REQUIRED FOR $600 OR MORE X-RAYS MUST BE ATTACHED IF CLAIM IS $600 OR MORE SEE INSTRUCTIONS ON REVERSE SIDE DENTAL CLAIM FORM Active Retired

How to fill out faculty dental claim form

How to fill out faculty dental claim form:

1. Obtain the faculty dental claim form from your dental insurance provider or your employer's human resources department.
2. Fill in your personal information accurately, including your full name, address, phone number, and any other requested details.
3. Provide your dental insurance information, including your policy number and the name of your insurance provider.
4. Indicate the date of service for your dental treatment and provide details about the dentist or dental office you visited.
5. Describe the nature of the dental treatment received and include any relevant codes or procedure numbers if provided by the dentist.
6. Attach any necessary supporting documentation, such as itemized receipts or dental treatment plans.
7. Review the completed form thoroughly to ensure all information is accurate and legible.
8. Sign and date the faculty dental claim form.
9. Submit the completed form to your dental insurance provider by mail or electronically through their online portal.

Who needs faculty dental claim form:

1. Employees or faculty members who have dental insurance coverage through their employer or organization.
2. Individuals who have received dental treatment and wish to seek reimbursement from their dental insurance provider.
3. Those who want to document and submit their dental expenses for tax purposes or reimbursement through a flexible spending account (FSA) or health savings account (HSA).

For pdfFiller’s FAQs

What is faculty dental claim form?

The faculty dental claim form is a document used to request reimbursement for dental expenses incurred by faculty members.

Who is required to file faculty dental claim form?

Faculty members who have dental expenses that they want to be reimbursed for are required to file the faculty dental claim form.

How to fill out faculty dental claim form?

To fill out the faculty dental claim form, you need to provide personal information, details of the dental treatment, and any supporting documents or receipts.

What is the purpose of faculty dental claim form?

The purpose of the faculty dental claim form is to facilitate the reimbursement process for faculty members who have incurred dental expenses.

What information must be reported on faculty dental claim form?

The faculty dental claim form typically requires information such as the faculty member's name, employee ID, treatment details, date of service, and total amount spent.

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