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.

Important Information

What are my individual and family plan options?
Check out all our Individual and Family Plan options to find a plan that best first your needs. If you'd like to stay on a legacy plan, you can review Delta Dental's Legacy Individual and Family Plan options.

Questions?

Hours:
Monday - Thursday: 7:30 A.M. - 5 P.M.
Friday: 7:30 A.M. - 4:30 P.M.

Toll-free Phone:
800.352.6132

Our mission is to improve lives by promoting optimal oral health.

Delta Dental of Arizona is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.

Information provided on this site is for general education purposes only and is not intended as a diagnosis, treatment or a substitute for professional medical or dental advice, diagnosis or treatment. For even more oral health information, check out the Protect My Smile library on the Delta Dental Plans Association website.