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Current Location:  Delta Dental of Arizona >Individual Plans >New Enrollment August 27, 2008
 

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.

 
1.
Select your dental policy, you have several options to choose from.
  --  Individual & Family Plan Details
 
2.

Print and complete the following electronic fund transfer (EFT) authorization form to setup electronic payment of your monthly premiums. Include your three-month premium payment check with the EFT form.  Your premium payment check must be from the same account as your monthly EFT withdrawals.

NOTE: After your three-month premium payment has been applied, your first EFT withdrawal will occur in the fourth month following your effective date. Click here for more information.

  --  Electronic Funds Transfer Authorization Form
  --  Sample Check with Routing Numbers

 
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 premium payment to:

Delta Dental of Arizona
P.O. BOX 63694
Phoenix, AZ 85082
  Click here to enter our secure website and complete the enrollment form.

 


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, click here

 

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