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PERSONAL INJURY PROTECTION INFORMATIONFirst Name Last Name Date of birth INSURANCE COMPANY: PHONE #: ADDRESS: CITY: ST: ZIP: Was this accident reported to your insurance company? () yes () Now If
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How to fill out dd form 2813 for
How to fill out dd form 2813 for
01
Start by obtaining a DD Form 2813, which is the Active Duty/Reserve/Guard/Civilian Armed Forces Health Benefits Election Form.
02
Fill out the personal information section, including your name, social security number, date of birth, and contact information.
03
Indicate the type of coverage you are electing, whether it's self-only, self and family, or other options available.
04
If you are currently a member of the Reserve Component, provide your current component, status, and effective date.
05
If you are a Reserve Component member electing dental coverage, indicate your dental readiness classification.
06
If you are electing dental coverage, fill out the desired dental plan section by indicating the dental plan code or provider name.
07
If you are adding eligible family members, provide their information in the appropriate section, including name, SSN, and relationship to the sponsor.
08
Sign and date the form, and ensure it is also signed by your unit commander or authorized representative.
09
Submit the completed form to the appropriate personnel or unit, as instructed by your command or administrative staff.
Who needs dd form 2813 for?
01
DD Form 2813 is needed by military members, including Active Duty, Reserve, Guard, and Civilian Armed Forces personnel.
02
It is necessary for individuals who want to make or change their health benefits election, including dental coverage.
03
It may also be required for family members who are being added or removed from the sponsor's health coverage plan.
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What is dd form 2813 for?
DD Form 2813 is used for reporting dental treatment provided to patients under the Defense Health Agency.
Who is required to file dd form 2813 for?
Healthcare providers within the military and affiliated dental facilities are required to file DD Form 2813.
How to fill out dd form 2813 for?
To fill out DD Form 2813, providers should include patient identification details, treatment codes, and any relevant notes on the dental care provided.
What is the purpose of dd form 2813 for?
The purpose of DD Form 2813 is to document and track dental care provided to eligible military personnel and their families.
What information must be reported on dd form 2813 for?
Information reported on DD Form 2813 includes patient name, Social Security number, treatment details, and provider information.
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