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
Application for Group Select Contract Patient Direct Discount Program
Group Select Checklist – 2018

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
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 – 2017 and 2018
Retiree Conversion Enrollment Form – 2017 and 2018

Individuals & Families

Application for Individuals & Families – 2018
Individual & Family Plan Comparisons – 2018

Federally Compliant Plans

Federally Compliant Plans Packet – 2018
Application for Group FCP – 2018

Request for Proposal

Request for Proposal Information Form

Supply Request

Order Group Supplies (email to request)

Web Links

Delta Dental National Dentist Directory
EyeMed Vision Care