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Delta Dental program brochure

This brochure provides a brief description of the Delta Dental PPO program.

For a detailed explanation of the dental benefits provided by the Health Plan, please refer to the Health Plan SPD.

Claim form

This claim form should be used if you are not using a Delta Dental PPO or Delta Dental Premier dentist. Remember, if you use a Delta Dental Premier dentist, the dentist's office will file the claim form for you.

Find instruction for completing the claim form here.

Dentist nomination form

Use this form if you want to nominate your dentist for participation in the Delta Dental PPO network.

The nomination process takes about 90 days and not all dentists choose to participate. Until your dentist is accepted into the Delta Dental PPO network, he or she is considered an out-of-network dentist.