Delta Dental Of Minnesota - Employers

Current Location: Delta Dental Of Minnesota > Employers > Forms & Publications

The following documents can only be viewed by using Acrobat® Reader® software, which can be downloaded free of charge from www.adobe.com.

Membership Enrollment Form (excludes Dental Flex)
Membership Enrollment Form - Spanish
Dental Flex Enrollment Form
Membership Maintenance Form (includes Dental Flex)
Disabled Dependent/Michelle's Law Application
Group Administration Manual
Online Enrollment User Request Form
Online Enrollment Brochure
Group Master Application (Pooled)
Group Master Application (Individually Rated)
International Emergency and Expatriate Dental Program Claim Form With Instructions for Members
HIPAA Designated Contact Form
DDMN Capabilities Brochure
DDMN Web Site Brochure
COBRA Premium Subsidy
COBRA Election Form for ARRA (this form is only for groups with less than 20 full-time employees)

To request a benefit summary for groups of 5-199 employees, please e-mail deltadentalconnect@deltadentalmn.org. Existing groups, please provide us with your group name or group number. For new groups, please provide us with the product name, deductible, orthodontics type (traditional or orthodontic discount program, if applicable) and maximum.

Billing Forms & Calendars