Get Dental Blue Application - The Tarnol Group Inc

Completing the Dental Blue Application is a straightforward process designed to help you enroll in dental coverage. This guide provides clear steps to ensure that your application is accurately filled out and submitted online.

Follow the steps to successfully complete your application.

1. Select the ‘Get Form’ button to retrieve the application form and open it for completion.
2. Fill out the application in blue or black ink, ensuring that you follow the instructions provided carefully. If you have any questions about specific fields or instructions, do not hesitate to reach out to the health insurance department at 818-379-4100.
3. Choose your preferred billing type from the options available: monthly, bi-monthly, or quarterly. Be sure to check the appropriate box indicating your choice.
4. Complete the applicant information section by providing your last name, first name, middle initial, home address, city, sex, birthdate, marital status, and social security number. If your billing address differs from your home address, please include that as well.
5. For those applying with a spouse or dependents, provide the required information for each spouse or child to be insured, including their names, sex, and birthdates.
6. Review the signatures section for required signatures, including your own, your spouse's, and any dependents aged 18 or over. Ensure all dates are also included.
7. Finally, after thoroughly reviewing the completed application for accuracy, send the application to MyEZhealthinsurance.com at the specified address. Attach your payment check, made payable to Anthem Blue Cross.

Complete your Dental Blue Application online today to ensure your dental coverage.