Benefit Application for Dental

APPLICATIONS MUST BE COMPLETE OTHERWISE THEY WILL NOT BE PROCESSED

All applications will be processed according to the date the it is received in our office. Your claim must show the amount paid by your insurance company, if applicable.

The maximum amount paid per Tribal Member for Dental Claims:

*Minor Treatment - $500.00 Per Year
*Braces - $1,000.00 Per Lifetime

*Major Treatment - $1,000.00 Per Year
*Dentures - $1,000.00 Per Lifetime


Form Downloads

Benefit Application for Dental