Delta Dental
Employer eKit

The Delta Dental Employer eKit provides you access to the various forms and resources, via the links below, to assist you with your group enrollment. Please review the Guidelines section for the pertinent details.

Once the items on the Enrollment Checklist have been completed, please return the completed forms and applications to your broker.

A second email, the Employee eKit, will arrive shortly. When you forward it to your employees they too will have access to resources and enrollment materials.

STEP 1:
Open, print and read the Delta Dental Enrollment Checklist provided below.

STEP 2:
Complete the Group Application provided below.

• The Group Application includes the Delta Dental benefit election options. Only complete the sections that pertain to the benefits you wish to offer your employees.
• If they were requested, links to Applications for other lines of coverage are shown below.
• Please discuss any questions you may have with your broker.

STEP 3:
Review the Enrollment Checklist to confirm you are completing all requirements.

• For example, a check for the exact amount due should be made payable to Delta Dental and submitted with the group employee applications.

• Enrollment Checklist
• Group Application (Delta Dental Only)
• Dental Employee Enrollment/Change Form
• Dental Employee Enrollment/Change Form - PPO Dual Choice Only
• Employee Census List
• HIPAA Authorization
• Initial Premium Authorization Form
• Prior Coverage Cancellation Letter
• Partial Payment Designation
• VSP Employer Application
• VSP Employee Application
• Personal Protection Plan Employer Application
• Personal Protection Plan Employee Application
• AXA Employer Application
• AXA Employer Verification Information

• Delta Dental Dentist Directory
• VSP Provider Finder
• Benefit Administrator Manual
• Small Business Advantage – Online Administration
• www.deltadentalins.com
• PPO ID Card Info (distribute to employees following receipt of group number)
• Employee Enrollment Kit (emailed separately)
• Plan Benefit Summaries (attached to email)
• Reply to this email if Explanation/Certificates of Coverage are needed.