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EMPLOYEE DENTAL ENROLLMENT and/or CHANGE FORM

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The document is an Employee Dental Enrollment and Change Form for the State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP). It outlines the process for employees to enroll in or change their dental coverage, including sections for personal information, reasons for application, level of coverage, selected dental plan, and dependent information. Additionally, it provides instructions on required documentation for dependent eligibility and enrollment, emphasizing the importance of accurate information and compliance with eligibility requirements.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (83 Votes)
2019	4.4 Satisfied (55 Votes)
2011	4 Satisfied (49 Votes)

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What is the purpose of an enrollment form?

Enrollment forms record whether employees have enrolled in or waived group benefits. For instance, if you have more than 50 full-time employees, you will need this data to complete IRS forms 1094 and 1095, which record health care coverage.

What is the meaning of enrollment in health insurance?

The process by which an eligible person becomes a member of an insurance plan.

What is a health Dental Enrollment Form?

This enrollment form allows individuals to apply for group health and dental coverage. Its designed for employees to provide necessary personal information, dependent details, and coverage choices.

What is a patient enrollment form?

A Hospital Patient Registration Form is a form template designed to streamline the process of collecting patient details before their stay in the hospital.