HOW DO I ENROLL?
- First, please read all the information contained in this Disclosure Form/Contract (particularly the Schedule of Benefits and Copayments, Limitations and Exclusions). This way you will know what procedures are covered and what your Copayments and Premium will be.
- Next, from the network directory, choose a dental facility that is convenient for you and for your family’s treatment.
- Finally, complete the Enrollment and Payment Authorization Form and indicate which contract facility you have chosen.
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