Download enrollment materials, enrollment change forms, product brochures and detailed benefit summaries below. If you would like supplies mailed to you, please email enrollment@embenefits.com or phone 630-238-1900.
FOR NEW GROUPS
Group Application
Dental Supplemental Questionnaire
Vision Supplemental Questionnaire
New Hire and Status Change Employee Enrollment Form
New Hire and Status Change Employee Enrollment Form (Spanish)
Employee Enrollment Form – Census Form
DELTA DENTAL INDIVIDUAL PRODUCTS
Delta Dental Individual Dental and Vision Brochure
2024 Delta Dental Individual Rate Sheet
Delta Dental Individual Dental Enrollment Form
Delta Dental Individual Vision Enrollment Form
BROCHURES
Dental Product Brochure
Delta Dental To Go Feature
DeltaCare DHMO Schedule of Benefits
Delta Dental Vision Brochure
CLAIM FORMS
Delta Dental Claim Form
If you would like to receive carrier information for Delta Dental, please visit our Broker Services page to request a kit.
REQUEST A BROKER KIT