SMALL BUSINESS RESOURCES

Quote to Covered® Materials

• Quote to Covered Flyer
• QTC training video
• QTC training document

Broker Kit

• Delta Dental Broker Kit

 

Forms & Applications

• Employee Enrollment Form
• Employee Enrollment Spreadsheet
• Small business ACH form
• Website Authorization for Pool-Rated Groups
• Direct Deposit Authorization
• Dental HIPAA Form 14a — Fully-insured groups 

Additional Small Business Information

• Benefits at a Glance
• How to service your small business clients

LARGE BUSINESS RESOURCES

Forms & Applications

• Employee Enrollment Form
• Website Authorization form for risk groups
• Website Authorization form for ASC groups
• Direct Deposit Authorization
• Dental HIPAA Form 14a — fully-insured groups 
• Dental HIPAA Form 14b — self-insured groups
• ASO contract addendum for HIPAA privacy and security

INDIVIDUAL & FAMILY PLAN RESOURCES

Forms & Applications

• Individual plans application
• Individual Broker Portal Form

Product & Plan Information

• Individual plan highlights brochure
• Individual rate flyer
• Individual brochure for retirees
• Commercial individual plans chart
• Virginia Insurance Marketplace plans chart

Broker Web Resources

• Broker individual web portal guide
• Broker individual quick start guide

VISION PLAN RESOURCES

Group Resources 

• DeltaVision Broker Kit
• Agent/Agency Data Request Form for Vision
• W-9
• Vision HIPAA Form 14a — Risk Groups
• Vision HIPAA Form 14b — ASO Groups

Delta Dental Individual and Family Plan™ Resources

• Individual and Family DeltaVision® Plans
• Individual DeltaVision rates flyer

 

MATERIALS & ADDITIONAL BENEFITS

Additional Benefits

• MaxOver™
• Healthy Smile, Healthy You®
• Right Start 4 Kids®
• Prevention First
• 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

Employer Resources

• For all employer-related resources, visit our employer resources page.

Member Resources

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

CONTACT US
 

• Small business contacts
• Small and large business contacts