Automated Clearinghouse Authorization Agreement For Preauthorized Payments
Delta Dental of Arizona requires small groups and renewing groups to make premium payments via ACH. As a courtesy to clients, an account for the Employer Connection will automatically be created for you. Please review the steps below and keep in mind that the accuracy of information is essential.
- Complete the form below to begin the ACH process.
- ACH withdrawals will begin for the billing cycle after the form is received.
- Invoices are run on the 15th of each month. You will receive an email around the 17th of each month that will include basic information on the amount of the withdrawal. You will need to log in to the Employer Connection to view the invoice.
- Premium payments are withdrawn on the first business day of the month.
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