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Dental
Insurance: Application
Quality
You Can Depend On
All
our dentists meet tough standards similar to those
of the NCQA (National Committee for Quality Assurance).
That means you and your family are in good hands.
In
addition, our Member Service department is committed
to your total satisfaction. Most calls are answered
by a knowledgeable representative in 30 seconds
or less.
Here’s
How You Get Started
- Choose
a dentist from the PacifiCare
California Participating Providers list.
- Call
the dentist of your choice and verify that he/she
is accepting new patients.
- Download
and print out the 511
Dental HMO Plan Member Enrollment form.
-
Indicate which dental office you’ve chosen
for you and your family and include a check
for your first month’s premium.
- Mail
the enrollment form and payment to:
PacifiCare Dental
P.O. Box 899
Tustin, CA 92781
- Make
sure your payment is received by the 20th of
the month to ensure coverage the following month.
If
you want to save on postage and time, select our
Pre-Authorized Payment Plan (Monthly Auto Pay)
which allows us to automatically debit your personal
checking account each month. (See the second page
of the Enrollment Application.)
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