Web1. Have your dentist complete Part 1. 2. Employee completes Parts 2 and 3. 3.you wish benefits to be paid directly to the dentist, sign the If assignment portion of Part 1 above. Assignment of benefits is irrevocable. Great-West Life may discuss details of this claim with the assignee. 4. Send this claim to: DATE OF SERVICE DAY MO. YR. Webpersonal information in your file by sending a request in writing to Great-West Life. Great-West Life may use service providers located within or outside Canada. We limit access to personal information in your file to Great-West Life staff or persons authorized by Great-West Life who require it to perform their duties, to persons to whom you ...
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