Get Application For Group Dental Coverage

Filling out the Application For Group Dental Coverage is a crucial step for employers seeking dental insurance for their employees. This guide provides a comprehensive, user-friendly approach to completing this application online, ensuring all necessary details are accurately provided.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the Application For Group Dental Coverage and open it in the editor.
2. Begin by entering the group number in the designated field, which is required for processing your application.
3. Fill in the requested effective date of coverage, specifying the month, day, and year when the coverage is expected to start.
4. Provide the legal name of the employer/group for whom the coverage is being sought, including any subsidiaries or affiliated companies.
5. Complete the contracting address section by entering the full street address, city, state, and zip code.
6. Include the phone number and fax number for the employer/group, ensuring the correct area codes are used.
7. Designate a group administrator by entering their name, title, and contact information in the appropriate fields.
8. If different from the administrator, provide the billing contact's name, phone number, and email address.
9. List the nature of your business and the years in operation, along with the relevant SIC code.
10. Fill out the funding information to indicate the employer's contribution towards employee and dependent insurance costs.
11. Describe the eligibility criteria, including the total number of eligible employees, enrollees, and waivers.
12. Choose the new hire eligibility dates for dental coverage and any applicable plan specifics.
13. Clearly state the monthly premium rates for the selected dental plans, ensuring accuracy in the rates listed.
14. Complete the employer/group agreement section by certifying the accuracy of the information provided, filling in your name, title, date, and signature.
15. Once you've entered all necessary information, review your application for any errors or omissions before saving changes, downloading, printing, or sharing the form.

Take the next step in securing dental coverage by completing the Application For Group Dental Coverage online.