Group Application
The application once completed and signed by the employer and agent is to be submitted to Delta Dental. Please note that new group acceptance will be considered after Delta Dental of Arizona receives the following:
- an application for group dental coverage completed and signed by the employer
Standard Application
- completed group enrollment forms
- a deposit check for the first month's premium
- a copy of the proposal outlining benefits
- Arizona Unemployment Tax & Wage Statement
Enrollment Forms
Enrollment forms must be submitted for all eligible employees, including those waiving coverage. Enrollment forms may be waived if an alternate eligibility reporting method is arranged in advance.
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