How do I enroll?



	Disclosure Form/Contract ("Contract") What is the DeltaCare USA Individual/Family Dental Program? How to use the Program / Choice of Contract Dentist Who is eligible for coverage? How do I enroll? What will my Effective Date be?

HOW DO I ENROLL? First, please read all the information contained in this Contract (particularly the Schedules of Benefits and Copayments and Limitations and Exclusions). This way you will know what procedures are covered and what your Copayments and Premium will be. Second, from the network directory, choose a dental facility that is convenient for you and for your family’s treatment. Third, complete the Enrollment and Payment Authorization Form and indicate which contract facility you have chosen.


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