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How to fill out the Great Eastern Dental online
Understanding how to complete the Great Eastern Dental Claim Form is essential for ensuring a smooth claims process. This guide provides clear, step-by-step instructions to help you navigate the form with ease.
Follow the steps to successfully complete the Great Eastern Dental Claim Form.
- Press the ‘Get Form’ button to access the claim form and open it in your preferred editor.
- In Part I, provide information about the employee, including their name, sex, and NRIC/Passport number. Additionally, indicate the plan type and the name of the employer (policyholder). Specify to whom the benefit payment should be made.
- Complete the patient details section by filling in the name of the patient, their NRIC/Passport number, sex, and relationship to the insured member. Ensure all information is accurate.
- For the authorized signatory section, include the name of the authorized signatory, their signature, and the date. Ensure to affix the company's stamp if necessary.
- In Part II, the dentist needs to list the examination and treatment details. Fill in the tooth order using the chart system, including tooth number or letter, surface, procedure code, a brief description if the procedure is not listed, the date of service, and the total fee charged.
- The dentist should sign and provide their name, address, qualification, and date, along with affixing their official stamp.
- In Part III, if the patient is a minor, the insured member should agree to the treatment and fees, certify the accuracy of the given information, and authorize Great Eastern Life to obtain necessary claim details. Include the date and signature of the patient or insured member.
- Once all sections are complete, review the document for accuracy. After confirming that all necessary information is provided, save the changes, download, print, or share the form as necessary.
Complete your Great Eastern Dental Claim Form online today for a seamless claims experience.
To submit claims for Great Eastern Dental, you will need to access their claims submission portal online. Gather all relevant documents such as your policy details and incident reports, then complete the online claim form. If you encounter any difficulties, uslegalforms can assist you with templates and guidance to make the submission process smoother.
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