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 – 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

Individual & Family Plans

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)

Web Links

Delta Dental Dentist Search
EyeMed Vision Care