Csea dental benefits form

Csea dental benefits form

Link: Download Csea dental benefits form


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Date added: 25.03.2015
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MAIL CLAIMS TO: CSEA EBF, P.O. BOX 489, LATHAM, NY 12110-0489. SUBMIT THIS CLAIM FORM FOR PAYMENT AFTER ALL DENTAL WORK IS

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Treatment by one of these providers does not require any claim forms and is To locate participating CSEA Dutchess Dental plan providers, visit the CSEALocal Government Dental Benefits. Over 2,200 participating dental offices in New York State. You may use any licensed dentist for dental care. The following SEE REVERSE SIDE FOR COMPLETE FILING INSTRUCTIONS. ' DENTAL CLAIM FORM . MAIL CLAIMS TO: CSEA EBF, PO. BOX 489, LATHAM, NY Dental Claim Form (94k) In addition to the EBF claim form, providers can submit claims electronically. Members can also use the ADA universal claim form that is

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Please be advised that Dental and Vision benefits are not affected by the Federal This form is used only to update/validate the CSEA EBF dependent student CSEA Sponsored Insurance Programs Retiree Dental Use this form to download the $5,000 Accidental Death Benefit Beneficiary Designation form. Dental coverage for CSEA union represented employees. You must fill in the top section of the claim form completely. The dentist's office will fill in the rest The Fund was established in 1979 and provides Dental and Vision benefits to CSEA members at the State of New York and local governmental level. If you are enrolling for a CSEA EBF Dental Plan, please answer the following: that you provide your domestic partner's social security number on this form.

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