delta dental

Enrollment Kit - delta dental / vsp (dental)

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This checklist is provided as a guide. The carrier may require additional items and documentation. Please refer to the carrier’s underwriting guidelines for a complete list of requirements. Please use the latest version of forms.

 

Our goal is to process your new group enrollment easily and efficiently in order to provide you and your client with a quick approval. The following list outlines Delta Dental's case submission requirements

 
  • Circle the plan selected on your sold Delta Dental produced quote and attach a copy

  • Group Application

  • Employee applications

    • ​​Enrollment / Change Form - DeltaCare USA

    • ​Enrollment / Change Form - PPO

    • Enrollment / C​hange Form - Dual Choice 

  • Current state quarterly wage report

  • Submit proof of prior coverage (copy of group’s prior EOC and last bill) for voluntary plans. 

  • Company check made payable to Delta Dental Insurance Company

  • Broker must be appointed by Delta Dental Insurance Company.

Licensing:  Broker appointment must be completed online.

 

NOTE: Delta Dental will accept broker licensing at the time of the broker's first sell/submission and not before. 

​After approval, prior carrier termination letter must be submitted by the employer or broker. 


For other useful or older documents, please refer to the Forms database.