Follow the steps to complete your enrollment efficiently.

1. Press the ‘Get Form’ button to access the Myambabenefits form and open it in your preferred document editor.
2. Begin by providing personal details in the 'Tell Us About Yourself' section, which includes your last name, first name, middle initial, gender, social security number, address, date of birth, phone number, and email address.
3. In the 'Prior Coverage Information' section, indicate if you have had continuous dental coverage for the past 12 months without a 60-day gap. If applicable, enter the name of your previous carrier and the effective date.
4. Select your desired coverage in the 'Select Your Coverage' section. Make sure to indicate your choice between dental, vision, or combined coverage, and check the corresponding boxes for membership types and rates.
5. Fill out the 'Dependents to Be Covered' section by listing the names, dates of birth, genders, and any necessary details for your spouse and dependent children. Ensure each dependent's information is clearly provided.
6. Proceed to the 'Payment' section. If you choose the convenient monthly bank payment option, enclose a check payable to AMBA for your first month’s premium and the one-time enrollment fee. Attach a voided check to authorize future withdrawals.
7. Review all completed sections to ensure accuracy. After confirming that all information is correct, sign and date the application where indicated.
8. Finally, submit your completed application to the address provided on the form. You may also save, download, or print a copy of your application for your records before mailing.

Complete your Myambabenefits form online today!