HOW DO I ENROLL?

1. 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.



2. Next, from the network directory, choose a dental facility that is convenient for you and for your family’s treatment.



3. Finally, complete the Enrollment and Payment Authorization Form and indicate which contract facility you have chosen.