Delta Dental of Minnesota provides several forms and resources to help you manage your employer group. Choose from the options below! Have questions? Please visit our Frequently Asked Questions section or contact us.
- Enrollment and Maintenance Forms
- Direct Debit Authorization (ACH) Form
- MN/ND Eligibility Enrollment/Update Form
- MN Membership Enrollment Form – Spanish (Small Group Pooled)
- MN/ ND Enrollment Form for Health Care Reform – Certified Group
- ND Membership Enrollment Form – Spanish (Small Group Pooled)
- Disabled Dependent/Michelle’s Law Application
- HIPAA Designated Contact Form
- Group Master Dental Applications
- MN Group Master Application (Small Group Pooled)
- MN Master Application for Health Care Reform – Certified Group Products
- ND Group Master Application (Small Group Pooled)
- ND Master Application for Health Care Reform – Certified Group Products
- Group Master Vision Applications
- DeltaVision® Group Master Application
- DeltaVision® Enrollment and Eligibility update form
- DeltaVision® Enrollment and Eligibility update form – Spanish
- Agent Forms
- Agent of Record Assignment Form Individuals
- Agent of Record Assignment Form Groups
- ACH Commission Agreement
- Employer Services Portal Access Forms
- Employer Services Portal – Client Access
- Employer Services Portal – Broker Access
- Employer Request and Claim Forms
Additional Resources
- Health Care Reform Resources