This is a dental plan only available to BCBS Service Benefit Plan Basic or Standard Option enrollees.
Please complete all items on this application. Any information missing may delay processing your application.
To enroll in Alabama Federal DentalBlue you must reside in the service area of Blue Cross and Blue Shield of Alabama. If you enroll in the FEHB Basic Option, you will automatically be enrolled in Alabama Federal DentalBlue Basic Option. The same is true for Standard Option.
BINDING ARBITRATION NOTICE
THE CONTRACT YOU'RE APPLYING FOR INCLUDES FINAL AND BINDING ARBITRATION.THIS MEANS ANY DISAGREEMENT NOT SETTLED BY THE EXTERNAL REVIEW PROCESS DESCRIBED IN THE HEALTH PLAN BOOKLET WILL BE SETTLED BY ARBITRATION-NOT A COURT. THE ARBITRATOR'S DECISION IS BINDING. AN ARBITRATOR IS AN INDEPENDENT, NEUTRAL PARTY WHO MAKES A DECISION AFTER LISTENING TO BOTH PARTIES. THE DECISION OF THE ARBITRATOR CAN'T BE REVIEWED BY A COURT, EXCEPT IN CERTAIN CIRCUMSTANCES AS DESCRIBED IN THE CONTRACT. THE ARBITRATOR ACTS AS JUDGE AND JURY. BY SIGNING BELOW YOU AGREE TO SETTLE ANY DISAGREEMENT BY ARBITRATION INSTEAD OF A COURT TRIAL.
Last Updated: 11/01/2017 00:14
You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. HealthEquity is our business associate and is an independent company that provides account-based plan services to Blue Cross. HealthEquity has agreed to follow Blue Cross' privacy and security policies regarding the confidentiality and protection of your personal health information.
To continue to the HealthEquity website, click "Accept." If you want to stay on Blue Cross' website, click "Cancel."
As an Alfa representative, I agree to the
payment terms and conditions of Blue Cross and Blue Shield of Alabama
and will not collect any checking account, debit card or credit card
information on behalf of the consumer for the purchase of health or
dental insurance.
To continue , please click "Agree."
As a CHA representative, I agree to the
payment terms and conditions of Blue Cross and Blue Shield of Alabama
and will not collect any checking account, debit card or credit card
information on behalf of the consumer for the purchase of health or
dental insurance.
To continue , please click "Agree."
You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by Vision Service Plan (VSP). VSP is our business associate and is an independent company that provides stand-alone vision insurance. VSP has agreed to follow Blue Cross' privacy and security policies regarding the confidentiality and protection of your personal health information.
To continue to the VSP website, click "Accept." If you want to stay on the Blue Cross website, click "Cancel."