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.

 

Forms

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

Business Forms for Group Select (2-99 Employees)

Group Select Packet - 2023
Application for Group Select Product - 2023
Group Select Checklist - 2023
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 - 2023
Application for Group Contract PDF (26+ Employees) - 2023
Group Application Checklist (26+ Employees) - 2023
EyeMed Plan Summary

Health through Oral Wellness® (HOW®)

Summary of HOW® Enhanced Benefits
Finding a HOW® participating dentist
 

Retiree Conversion Form

Retiree Conversion Overview - 2023
Retiree Conversion Enrollment Form - 2023
 

Individuals & Families

Individual & Family Plans

Federally Compliant Plans

Federally Compliant Plans Packet - 2023
Application for Group FCP - 2023
 

Request for Proposal

Request for Proposal Information Form

Supply Request

Order Group Supplies (email to request)

Web Links

Delta Dental Dentist Search
EyeMed Vision Care