Alabama Federal DentalBlue Enrollment

Select Plan

  • 1. Select Plan
  • 2. Personal Information
  • 3. Agreement
  • 4. Payment
  • 5. Confirmation

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.

Please provide complete information in each of the sections below, then click 'Next' to continue.

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Standard Self   R$ 28
Standard Self Plus One   R$ 53
Standard Self Family   R$ 59
Basic Self   R$ 18
Basic Self Plus One   R$ 34
Basic Self Family   R$ 39