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Get Ghi Dental Claim Form 2014-2023

MAIL COMPLETED DENTAL CLAIM FORM TO GHI P. O. Box 2838 New York NY 10116- 2838 CATEGORYIGROOP 1 SUBSCRIBER SCERT FICATENUMBER lTPATIENrs RRSr 2. Dental coverage is subject to specific limitations and exclusions. Please refer to your insurance booklet and certificate for a description of covered services limitations and exclusions. 3. All Claim forms must be submitted to GHI no later than 180 days after the end of the calendar year in which the se.

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