Steps for completing a dental claim by using the paper form
You can file a dental claim to receive benefits for over 400 routine and extensive procedures, including:
- Tooth removal
Use these steps to guide you through the process of filing a dental claim. If you need to submit an accident insurance or vision rider claim as well, download the accident claim and vision claim forms.
- Download the dental policy claim form.
- Have the dentist who treated you complete the form in its entirety.
- Sign and date the Authorizations section.
- Carefully review your forms to ensure all required sections are completed, including all areas where a signature and date are needed.
- Your dentist may submit the claim electronically. Alternatively, you can fax your claim to 1-855-855-1575 (Attn: Dental Claims) or mail it to P.O. Box 30507, Salt Lake City, UT, 84130.
- All dental claims are processed by HealthPlanServices. To check the status of your dental policy claim, call 877-477-4065, or visit HPSClaimServices.com.