To submit a manual claim, complete an insurance
Dental Claim Form, attach the original receipts and documents, and mail to the insurer. Remember to keep a copy of all original documents for your records.
The following information is required on the claim form:
Plan Number: 123456
Division Number: Not Applicable Leave Blank
Plan Name: SCHOOL
Employee Identification Number: Your Student ID
Employee Name: Your Name
Address: Your Current Mailing Address