Get the free Green Shield Dental Claim Form

PO Box 1608, Windsor, Ontario N9A 7G1 Attn: Dental Department or CUSTOMER SERVICE Center 1888711 1119 DENTAL CLAIM FORM PART 1 PROVIDER Patient Last Name P A T I E N T Given Name Address Province

How to fill out green shield dental claim

How to fill out green shield dental claim:

1. Start by gathering all necessary information: Make sure you have your Green Shield dental claim form and any relevant receipts or invoices from your dentist.
2. Fill in personal details: Begin by entering your personal information, such as your name, address, and policy number. This information is important for Green Shield to properly process your claim.
3. Provide dentist information: In the designated section, provide the name and contact details of your dentist. This ensures that Green Shield can reach out to them if needed.
4. Specify treatment details: Indicate the date of the dental treatment and describe the specific procedures that were performed. This could include routine check-ups, cleanings, fillings, or more complex treatments like root canals or extractions.
5. Enter cost information: Record the total cost of the dental treatment and any applicable taxes. If you have multiple receipts, make sure to add up the costs and provide the accurate total.
6. Attach receipts: Attach the original receipts or invoices from your dentist to the claim form. Green Shield requires these supporting documents as proof of the services received.
7. Submit the claim: Once you have completed all the necessary sections of the claim form and attached the receipts, review everything for accuracy. Make sure all the information is correct and legible.
8. Keep a copy for your records: Before sending the claim, make a copy of the completed form and all supporting documents for your own records. This way, you have a backup in case anything gets lost in the mail.
9. Send the claim: Mail the completed claim form and receipts to the designated address provided by Green Shield. You may also have the option to submit your claim electronically through their online portal if available.
10. Wait for reimbursement: After submitting your claim, Green Shield will review the information and process the reimbursement accordingly. Typically, you will receive a check or a direct deposit for the eligible amount within a certain timeframe.

Who needs green shield dental claim:

1. Individuals who have Green Shield dental coverage through their insurance plan.
2. Those who have received dental treatment and wish to be reimbursed for the expenses incurred.
3. Individuals who want to take advantage of their dental benefits and minimize out-of-pocket costs.
4. People who want to maintain their oral health and ensure regular dental check-ups and treatments are covered by their insurance.

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What is green shield dental claim?

Green Shield Dental Claim is a form used to submit requests for reimbursement of dental expenses covered by Green Shield insurance.

Who is required to file green shield dental claim?

The policyholder or the insured individual is required to file the Green Shield dental claim.

How to fill out green shield dental claim?

To fill out a Green Shield dental claim, you need to provide detailed information about the dental services received, the cost, and any other relevant details requested on the claim form.

What is the purpose of green shield dental claim?

The purpose of Green Shield dental claim is to request reimbursement for dental expenses covered under the insurance plan.

What information must be reported on green shield dental claim?

The Green Shield dental claim form typically requires information such as the date of service, description of the service provided, the cost, the dental provider's information, and the insured individual's details.