MAKING PLAN CHANGES AND FILING CLAIMS. All of the forms necessary to make changes to the plan can be obtained from the employer’s personnel office, from Our home office. If the Member needs to submit documentation to Us, the Member may forward it to Our home office at: Blue Cross and Blue Shield of Louisiana P.O. Box 98029 All the forms related to filing claims under this Benefit Plan can be obtained by contacting United Concordia Dental at: P.O. Box 69441 Harrisburg, PA 17106-9441 ▇-▇▇▇-▇▇▇-▇▇▇▇ If the Member has any questions about any of the information in this section, the Member may speak to his Employer or call UCD. Members may be able to perform many of these functions online at ▇▇▇.▇▇▇▇▇▇.▇▇▇. The Schedule of Eligibility lets You know when You may add additional family Members to Your policy. Please read the Schedule of Eligibility and this section as they contain important information for You. A Group Enrollment Change Form is the document that We must receive in order to enroll family Members not listed on Your original application/enrollment form. The Group Enrollment Change Form is used to add newborn children, newborn adopted children, a Spouse, or other Dependents. It is extremely important that You follow the timing rules in the Schedule of Eligibility. If You do not complete and return a required Group Enrollment Change Form to Us within the timeframes set out in the Schedule of Eligibility, it is possible that Your insurance coverage will not be expanded to include the additional family Members. Completing and returning a Group Enrollment Change Form is especially important when Your first Dependent becomes eligible for coverage or when You no longer have any eligible Dependents.
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