Csudh dental insurance form 2026

1. Click ‘Get Form’ to open the csudh dental insurance form in the editor.
2. Begin with Section A, where you will indicate the type of action: enrolling, cancelling, or changing coverage. Fill in your name and social security number.
3. In Section B, provide details about the dental plan you are enrolling in, including the provider/facility number if applicable. List all family members currently enrolled and specify any changes.
4. Complete Section C only if you are changing plans; otherwise, skip to Section D. Here, indicate your prior dental plan name if applicable.
5. In Section D, check the appropriate box to confirm your enrollment decision and authorize deductions from your salary. Sign and date the form at the bottom.

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