Forms & Resources

Find the forms and resources to assist you in administering Delta Dental of Oklahoma benefit products and services. PDF forms may be downloaded.

Individuals & Families

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

Business Forms for Group Select (2-99 Employees)

Group Select Packet – 2017
Application for Group Select Product – 2017
Application for Group Select Contract Patient Direct Discount Program
Group Select Checklist – 2017
Employee Enrollment Form Group Select – English
Employee Enrollment Form Group Select – 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
Request for Proposal PDF (26+ Employees)
Application for Group Contract PDF (26+ Employees) – 2017
Group Application Checklist (26+ Employees) – 2017
Employee Enrollment Form (26+ Employees) – English
Employee Enrollment Form (26+ Employees) – Spanish

EyeMed Plan Summary

Federally Compliant Plans

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

Retiree Conversion Form

Retiree Conversion Overview – 2017
Retiree Conversion Enrollment Form – 2017

Forms

Automatic Draft Authorization Form
Employee Enrollment Form – English
Employee Enrollment Form – Spanish
General Change Form for Groups (editable)
Application for Online Resources (editable)
 

Supply Request

Order Group Supplies (email to request)

Web Links

Delta Dental National Dentist Directory
EyeMed Vision Care