Use this form when you want to submit a dental claim under your health spending account.Įxtended health care – standard claim form (EHC-E) To fill out the form, first right click the link to download it, then open it in a system viewer like Adobe.ĭental claim – health spending account claim form (DENT-HSA-E) This is a fillable PDF and cannot be completed in a browser. Use this form when you want to submit a dental claim under your regular dental coverage. ![]() If so, you can find the most popular non-personalized group claims forms here.* Dentalĭental claim – standard claim form (DENT-E) Your employer or organization may not have personalized claims forms.
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