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Find the forms and resources to assist you in administering Delta Dental of Oklahoma benefit products and services. PDF forms may be downloaded.
Forms
Automatic Draft Authorization Form
Employee Enrollment Form – 2018 – English
Employee Enrollment Form – 2018 – Spanish
General Change Form for Groups (editable)
Application for Online Resources (editable)
Business Forms for Group Select (2-99 Employees)
Group Select Packet – 2018
Application for Group Select Product – 2018
Group Select Checklist – 2018
Group Select Packet – 2019
Application for Group Select Product – 2019
Group Select Checklist – 2019
Application for Group Select Contract Patient Direct Discount Program
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 – 2018
Application for Group Contract PDF (26+ Employees) – 2018
Group Application Checklist (26+ Employees) – 2018
Group 26+ Packet – 2019
Application for Group Contract PDF (26+ Employees) – 2019
Group Application Checklist (26+ Employees) – 2019
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
Retiree Conversion Form
Retiree Conversion Overview – 2018
Retiree Conversion Enrollment Form – 2018
Retiree Conversion Overview – 2019
Retiree Conversion Enrollment Form – 2019
Individuals & Families
Federally Compliant Plans
Federally Compliant Plans Packet – 2018
Application for Group FCP – 2018
Federally Compliant Plans Packet – 2019
Application for Group FCP – 2019
Request for Proposal
Request for Proposal Information Form
Supply Request
Order Group Supplies (email to request)