Dental ClaimGroup BenefitsManulife Use this form to submit dental claims to the group benefits plan 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Part 1 - Dentist information. Enter the dentist's last name, given name, address, and contact details accurately.
3. In Part 2 - Plan Member Information, provide your plan contract number, member name, and date of birth. Ensure all details are correct for smooth processing.
4. Complete Part 3 - Patient Information. Indicate the relationship to the plan member and answer any questions regarding work-related incidents or other insurance coverage.
5. Fill in Part 4 - Banking Information if you wish to set up direct deposit for claim payments. Include your transit number, institution number, account number, and email address for notifications.
6. Review and sign Part 5 - Authorization and Consent. Make sure you understand the terms before submitting your claim.
7. Finally, follow the mailing instructions in Part 6 to send your completed form to the appropriate address based on your location.

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