Forms, brochures and guides Oregon

Guides and documents

• How to read an EOB – a quick guide to help your employees understand an EOB

Forms for employees and administrators

Enrollment application & change of information forms

• Dental
• Dental (Español)
• Dual Dental plan
• Dual Dental plan (Español)
• Claim form – Log in to Employer dashboard to access your dental claim forms
• Complaint and appeal form – use this form to file an appeal or a complaint
• Coordination of Benefits form – use this form to give us information about other dental or health plans your employees may have
• Disabled Dependent Certification form – use this form to certify a disabled dependent
• Domestic partnership documentation for qualified plans – use this form for domestic partnership documentation
• Privacy Disclosure – Authorize Delta Dental to use/disclose information about a member (Instructions)
• Dental provider nomination form – use this form to nominate a provider to one of our networks
• Group Size Determination Form – use this form to see if you qualify for being a small group

Brochures

• 2024 OR Small Group Medical Dental Brochure