Please fill out this form to enroll into the temporary dental out-of-pocket reimbursement program offered by Carewell SEIU 503. Once we process your form, you will receive reimbursement for your 2021 out-of-pocket expenses (coinsurance and copays) for services covered under your Kaiser Permanente dental plan offered through Carewell SEIU 503.
This reimbursement benefit is not available for services received before January 1, 2021 or after December 31, 2021. Also, the maximum total amount that Carewell SEIU 503 will pay to all participants under this temporary program is $700,000. Therefore, if that limit is reached before all reimbursement requests for services received in 2021 have been processed, this temporary program will end and no further reimbursements will be paid.