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Form STD696 Dental Plan Direct Payment Authorization - California
What Is Form STD696?
This is a legal form that was released by the California Department of Human Resources - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form STD696?
A: Form STD696 is a Dental Plan Direct Payment Authorization form used in California.
Q: What is the purpose of Form STD696?
A: The purpose of Form STD696 is to authorize direct payment of dental plan benefits to the dentist.
Q: Who uses Form STD696?
A: Form STD696 is used by individuals in California who have a dental plan.
Q: What information is needed to complete Form STD696?
A: To complete Form STD696, you will need to provide your personal information, dental plan information, dental office information, and dental treatment details.
Q: Is Form STD696 specific to California?
A: Yes, Form STD696 is specific to California. Other states may have different forms for dental plan direct payment authorization.
Q: Are there any fees associated with submitting Form STD696?
A: There are no fees associated with submitting Form STD696. It is a free form provided by the California Department of Human Resources.
Form Details:
- Released on October 1, 2019;
- The latest edition provided by the California Department of Human Resources;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form STD696 by clicking the link below or browse more documents and templates provided by the California Department of Human Resources.
Download Form STD696 Dental Plan Direct Payment Authorization - California
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