FORMS & APPLICATIONS

Small business (Fewer than 100 employees) 

• Small group application
• Small group subscriber enrollment/change form
• Website authorization form for pool-rated groups

Large business (100+ Employees) 

• Large group subscriber enrollment/change form
• Website authorization form for fully-insured groups
• Website authorization form for self-insured groups

Other Forms

• ASO contract addendum for HIPAA privacy and security
• Healthy Smile, Healthy You® enrollment form
• Healthy Smile, Healthy You® enrollment form — Spanish
• Group Information Change Request Form
• Automatic bank draft authorization for risk groups
• Automatic bank draft authorization of weekly claims and monthly admin fees for self-insured groups
• Automatic bank draft authorization of monthly claims and monthly admin fees for self-insured groups

FLYERS & OTHER RESOURCES

Benefit Flyers & Brochures

• Healthy Smile, Healthy You®
• Prevention First
• Right Start 4 Kids®
• Special Health Care Needs
• Delta Dental — Virtual Visits
• Amplifon Hearing Discount
• Special Health Care Needs Benefits for self-insured groups
• Special Health Care Needs Benefit for fully-insured groups

Other Resources

• Employer website quick reference guide
• Mobile app flyer
• Portal reports guide for employers
• Online Billing Guide
• Online Billing FAQ
• ASC Weekly Claims Invoice FAQ
• Video: Quoting tool
• Video: Account structure
• Video: Enrollment
• Video: Billing
• Voluntary dental benefits resources
• Video: Why are dental benefits important?

VISION RESOURCES

Forms

• HIPAA Form 14a — fully-insured groups
• HIPAA Form 14b — self-insured groups

Other Vision Resources

• DeltaVision® plan comparison sheet
• DeltaVision network flyer
• KidsCare flyer
• LightCare flyer
• EasyOptions flyer
• Medical eye care flyer
• Laser eye surgery flyer
• Blue light flyer
• Diabetic eyecare plus program flyer

Oral Health Resources

2024 Monthly eTips

eTips Calendar 

• Nutrition & your smile: Foods that keep teeth healthy 
• Show your love with healthy smiles — February 2025
• New year new me: Setting your dental goals for the year — January 2025
• Balancing holiday treats and healthy smiles — December 2024
• Protect budgets and smiles this season — November 2024
• Treat your teeth right this Halloween — October 2024
• Benefits you didn't know existed — September 2024
• Prepare for a healthy school year — August 2024
• Beat the heat with healthy treats — July 2024
• Shade the day — June 2024
• Coinsurance 101: What you need to know — May 2024
• In-network vs Out-of-network explained — April 2024
• Brush up your smile this spring — March 2024
• Celebrating children's dental health month — February 2024
• How dental benefits can save you money! — January 2024

Grin Magazine 

• 2024 Fall edition
• 2024 Summer edition
• 2024 Spring edition
• 2023 Winter edition
• Grin web magazine

Oral health resources

• ADHD flyer
• ADHD flyer (Spanish version)
• Alzheimer flyer
• Alzheimer flyer (Spanish version)
• America's Oral Health Report
• America's Oral Health — Summary
• Anxiety Flyer
• Anxiety Flyer (Spanish version)
• Breast Cancer flyer
• Delta Dental oral health library
• Diabetes flyer
• Opioids information
• Oral Cancer flyer
• Oral health brochure
• Oral health brochure (Spanish version)
• Oral health and overall wellness flyer
• Orthodontic benefits flyer
• Tobacco flyer
• TMJ flyer
• Implants flyer
• Nutrition flyer
• Sealants flyer
• Tooth Fairy Hideout — help kids get interested in oral health
• Video: Why are dental benefits important?
• Video: Oral Health and overall health
• Video: What is a deductible
• Video: What is a pre-treatment estimate?
• Video: What to look for in a dental plan?
• Video: The value of dental benefits

Glossaries

• Oral health terms
• Dental benefit terms

EMPLOYEE RESOURCES

For all employee-related resources, visit our member resources page.