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GROUP DENTAL ENROLLMENT FORM
New Employee
Open Enrollment Dependent
RehireDelete Dependent
Address/Name ChangeCancel/Waive
Loss of Other CoverageName of Employer:Group Number:National Payroll Specialists
Plan
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What is group dental enrollment form?
A group dental enrollment form is a document used by employers or organizations to enroll employees and their dependents in a dental insurance plan offered by the group.
Who is required to file group dental enrollment form?
Employers or organizations offering group dental insurance plans are required to file the group dental enrollment form for their eligible employees and their dependents.
How to fill out group dental enrollment form?
To fill out a group dental enrollment form, provide personal information such as names, addresses, and social security numbers of the employees and their dependents, select the desired coverage options, and sign the form.
What is the purpose of group dental enrollment form?
The purpose of the group dental enrollment form is to gather necessary information to enroll employees and their dependents in the dental insurance plan and to establish eligibility for coverage.
What information must be reported on group dental enrollment form?
The information that must be reported includes the employees' names, dates of birth, social security numbers, address, relationship to the employee, and any previous dental coverage details.
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