NNEBT

Resources and Forms

Dental Fee Schedule - 2007	Prescription Credit Card Authorization
Dental Fee Schedule - 2008	Prescription - Mail Order Form
Dental Breakdown of Benefits	Prescription - Patient Profile
Disability Claim Form (Short Term)	Prescription - Prior Authorization Form
Health Club Reimbursement Claim Form	TBH Release of Information
Massage Therapy Claim Form	TBH Treatment Plan
These forms are posted here for your convenience. Not all benefits represented here pertain to every plan. Please be certain to check your employer's plan benefits to ensure that you are eligible for the benefit.