Joining Arizona's largest provider of dental benefits is simple and convenient. All the information you need to enroll in the plan, understand your benefits, and learn about our privacy policies is available below. If you have questions or would like to enroll over the phone, please call 602.588.3624.
Individual Plan enrollment
is for consecutive 12-month period(s) and monthly
premium payments are drafted by electronic fund transfer (EFT).
1. |
Select your dental policy, you have several options to choose from.
-- Individual & Family Dental Plan Details |
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2. |
Complete the enrollment form online and choose one of our three options to make your 3 month premium payment:
- Print out, date and sign the application and mail in with your payment
- Pay by credit card
- Pay by electronic check
NOTE: After your three-month premium payment has been applied, your first EFT withdrawal will occur in the fourth month following your effective date.
For more information regarding EFT transactions, click here to access the Frequently Asked Questions page.
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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3. |
Use our secure site (click
the "continue" text
below) to complete your Individual
& Family Plan enrollment form.
Mail the completed enrollment form, EFT authorization form and initial 3 month
premium payment to:
Delta Dental of Arizona
P.O. BOX 63694
Phoenix, AZ 85082
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Adobe Acrobat Reader is required to view the PDF documents. If you do not have Adobe Acrobat Reader installed on your computer, you can download it free --
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