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Current Location:  Delta Dental of Arizona >Individual Plans >Family Status Change Form March 16, 2010
Family Status Change Form
 

Are you already an Individual Plan member and need to make changes???

Why do you need the Change of Status Form?

  • You want to add or remove dependents.
  • You had a qualifying event change in your family.
    (Marriage, Divorce, Adoption, Birth, Other)
  • You want to change your name or the name of one of your dependents.
  • You want to change your address.
  • You want to change your coverage type.
  • You want to make changes to your EFT payment account.

ONLY adding vision coverage to your dental policy, CLICK HERE.

Go to the change enrollment form


NOTE: Changes due to qualifying events must be submitted within 31 days from when the event occured. Any changes you would like to make to your plan can be submitted through a change of status form on your renewal date.

 

 

 

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