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P.O. Box 83149, Lancaster, PA 17608-3149 GROUP DENTAL CLAIM APPLICATION Instructions for the Employee This form must be used when presenting a claim for dental benefits under your Employer s Group
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What is group dental claim application?
A group dental claim application is a form that is submitted to an insurance company by a group policyholder to request reimbursement for dental services provided to employees.
Who is required to file group dental claim application?
The employer or group policyholder is typically required to file the group dental claim application on behalf of their employees.
How to fill out group dental claim application?
The group dental claim application can typically be filled out online or on paper, and requires information such as the patient's name, date of service, type of service provided, and total cost.
What is the purpose of group dental claim application?
The purpose of the group dental claim application is to request reimbursement from the insurance company for dental services provided to employees covered under a group policy.
What information must be reported on group dental claim application?
Information that must be reported on a group dental claim application includes the patient's name, date of birth, policy number, provider information, date of service, type of service provided, and total cost.
How can I send group dental claim application to be eSigned by others?
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