You must have all information to Fidelity Capital Management by the 15^th of the month 
in order to have your coverage effective the 1^st of the following month.

Individual members may enroll themselves and their family or firms can enroll their employees and pay one bill for everyone. Dental premiums are eligible to be paid pre-tax.

• Print out the application form.
• Complete and sign the application. (Complete information on all dependents you wish to include. Remember: There is no charge for children under 2 years. However, for our records, we ask you to list those who will be covered in the future.)
• Mail completed application to Fidelity Capital Management at the address below.
• Write "VOID" on a sample check showing the account number and bank from which the monthly premium is to be drafted.
• Print out and complete bank draft authorization form. 
• Write a check payable to NCAR Dental Plan for the first month's premium, plus the one time administrative fee of $10.00.*

* Firms who wish to have a monthly list bill covering more than one employee will be billed monthly. The administrative fee is $10.00 per firm, not per employee.
 

Mail: 1. Application 2. Bank Draft Authorization 3. VOIDED Check for bank draft 4. Check payable to "NCAR Dental Plan"

To:  Fidelity Capital Management Attn: NCAR 3008 Anderson Dr. Suite 203 Raleigh, NC 27609

You will receive your Policy Summary, I.D. cards, claim forms, etc. within 3 weeks after your enrollment is processed at the Home Office. 

For more information
Problems? Questions? Feel free to call or email Ed Williams, Rand Williams, or MJ Trunecek at Fidelity Capital Management.

Fidelity Capital Management
3008 Anderson Dr., Suite 203
Raleigh, North Carolina 27609
Telephone: (919) 876-9610; FAX: (919) 850-9320
Agent: Ed Williams
E-mail:capital12@mindspring.com

       Last Modified: 6/26/06