Get Ar Delta Dental Individual And Family Retiree Program 2019-2025

This guide provides you with clear, step-by-step instructions on how to complete the AR Delta Dental Individual And Family Retiree Program online. It is designed to support you in efficiently navigating the form and ensuring accurate submission.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the form and open it in your document editor.
2. Begin by filling out the applicant information section. Provide your name, date of birth, sex, mailing address, social security number, phone number, and email address. Make sure the email provided is one you check regularly, as important communications will be sent there.
3. In the plan selection area, choose whether you want dental coverage alone or in combination with vision coverage. Select the appropriate option for individual or family coverage.
4. Complete the dependents section by listing the first name, last name, date of birth, and sex for each dependent you wish to include under the plan.
5. Indicate whether this application will replace any existing dental coverage. If yes, provide the anticipated termination date of your current plan and include necessary documentation as required.
6. Fill in the payment method section. Select either bank draft or credit card as your payment option. If choosing credit card, ensure to enter the card type, number, expiration date, CVV, and the cardholder’s name and signature.
7. Complete the authorization and certification section by signing and dating where indicated. This confirms your acknowledgment and acceptance of the terms outlined in the application.
8. Once all fields are completed, review your entries for accuracy. Then, save your changes, download, print, or share the form as needed, ensuring you follow up with the submission process before the application deadline.

Complete your application online today to secure your dental coverage.