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Nazarene United Soccer Club Doc TemplateDocHub 2025

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The document is an application form for enrolling in a 2020 BlueCare Dental Plan offered by Blue Cross and Blue Shield of Texas (BCBSTX). It outlines the necessary steps for applicants to sign up, including providing personal information, payment details, and eligibility for special enrollment periods. The form requires applicants to answer questions about themselves and their dependents, select a dental plan option, and agree to billing rules. Additionally, it emphasizes the importance of accurate information and signatures for processing the application.

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Click ‘Get Form’ to open the Nazarene United Soccer Club Doc Template in our editor.
Begin by entering your Applicant Name and SSN# in the designated fields at the top of the form.
Select your desired dental plan option by checking the appropriate box under 'Choose your dental plan.'
Fill out all required personal information, including contact details and preferences for communication.
If applicable, provide information about any dependents you wish to enroll, ensuring all fields are completed accurately.
Review the payment options section and select how you will make your first payment, ensuring to include necessary banking details if opting for EFT.
Sign and date the application at the end of the document to confirm your agreement with the terms outlined.

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2019	4.8 Satisfied (62 Votes)

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