Get Manulife Gl3586e 2020-2025

This guide will help you navigate the process of completing the Manulife GL3586E dental claim form online. By following the provided instructions, you can efficiently submit your claim while ensuring all necessary information is accurately reported.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in your document management tool.
2. Begin by filling in the dentist's information in Part 1, including their last name, given name, address, city, unique account number, and phone number.
3. In the assignment section, confirm that you are assigning your benefits payable from this claim to the named dentist by marking the corresponding authorization box.
4. Sign as the plan member to acknowledge understanding of financial responsibilities related to treatment costs and to authorize the release of information to the insuring company.
5. In Part 2, provide the necessary details such as plan contract number, plan member name, sponsor, and birthday, along with your daytime phone number.
6. Part 3 requires you to describe the patient’s relationship to the plan member and indicate if there are any work-related incidents or other insurance coverage.
7. Complete Part 4 by providing your banking information if you prefer direct deposit and an email address for notifications regarding your claim status.
8. In Part 5, read through and accept the authorization and consent terms by signing and dating the form.
9. Finally, if required, mail the completed claim form and receipts to the appropriate address listed in Part 6 based on your location.

Complete your Manulife GL3586E dental claim form online today to ensure a smooth claims process.