Legacy Individual Plan: Change of Status Form

Use this secure form to manage your legacy individual dental or vision plan policy information. Changes due to qualifying events must be submitted by the 10th of the month preceding your renewal date for your changes to take effect. Note: If you purchased your Individual and Family Plan after August 22, 2013, please visit DeltaDentalCoversMe.com or call 888.899.3734 to modify your coverage.

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