Forms & Resources

Find the useful forms to assist you with selling and administering Delta Dental of Oklahoma products and services.

Request for Proposal

Request for Proposal Information Form

Business Forms for Group Select (2-99 Employees)

Group Select Packet – 2017
Group Select Packet – 2018

Application for Group Select Product – 2017
Application for Group Select Product – 2018
Application for Group Select Contract Patient Direct Discount Program
Group Select Checklist – 2017
Group Select Checklist – 2018
Employee Enrollment Form Group Select – 2017 – English
Employee Enrollment Form Group Select – 2018 – English
Employee Enrollment Form Group Select – 2017 – Spanish
Employee Enrollment Form Group Select – 2018 – Spanish
Employee Enrollment Form for Patient Direct Discount Program – English
Employee Enrollment Form for Patient Direct Discount Program – Spanish
Select Benefit Summaries – English
Select Benefit Summaries – Spanish
EyeMed Plan Summary
 

Business Forms For Groups (26+ Employees)

Group 26+ Packet – 2017
Group 26+ Packet – 2018
Application for Group Contract PDF (26+ Employees) – 2017
Application for Group Contract PDF (26+ Employees) – 2018
Group Application Checklist (26+ Employees) – 2017
Group Application Checklist (26+ Employees) – 2018
Employee Enrollment Form (26+ Employees) – 2017 – English
Employee Enrollment Form (26+ Employees) – 2018 – English
Employee Enrollment Form (26+ Employees) – 2017 – Spanish
Employee Enrollment Form (26+ Employees) – 2018 – Spanish
EyeMed Plan Summary

Business Forms For Group PPO - No Max (100+ Employees)

PPO - No Max 100+ Packet – 2018 and 2019
Application for PPO - No Max PDF (100+ Employees) – 2018 and 2019

Group Application Checklist PPO - No Max PDF (100+ Employees) – 2018 and 2019
Employee Enrollment Form PPO - No Max – 2018 and 2019 – English
Employee Enrollment Form PPO - No Max – 2018 and 2019 – Spanish

Retiree Conversion Form

Retiree Conversion Overview – 2017
Retiree Conversion Enrollment Form – 2017

 

Individuals & Families

Application for Individuals & Families – 2017
Individual & Family Plan Comparisons – 2017

Federally Compliant Plans

Federally Compliant Plans Packet – 2017
Application for Group FCP – 2017

Forms

Automatic Draft Authorization Form
Employee Enrollment Form – 2017 – English
Employee Enrollment Form – 2018 – English
Employee Enrollment Form – 2017 – Spanish
Employee Enrollment Form – 2018 – Spanish

General Change Form for Groups (editable)
Application for Online Resources (editable)
 

Supply Request

Order Group Supplies (email to request)

Web Links

Broker Exchange (Please login to Broker Exchange to generate a proposal)
Delta Dental National Dentist Directory
EyeMed Vision Care



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