Notice
On May 21st, our call center will operate from 8 AM to 11:45 AM and will be closed in the afternoon.
From Friday May 23rd through Friday, August 29, 2025: Customer Service hours will be 8:00 AM – 6:30 PM EST Monday through Thursday and 8:00 AM - 1:00 PM EST on Friday.
To view benefit information and claim status at any time, you can sign into your account or use our Interactive Voice Response System 24/7 at 800-452-9310.
Dental Forms for Brokers
Find a variety of helpful forms or applications to keep your client’s information updated.
Small group forms for brokers
Small Business Program Group Dental and Vision Application (PDF, 9 pages, 1,570 KB)
Delta Dental CT Enrollment Template (Excel Spreadsheet)
Enrollment/Change Form (Dental and Vision) (PDF, 1 page, 204kb)
Individual Commissions Forms
Producer Appointment Forms (pdf, 26 pages, 789KB)
Standard Forms for Brokers
Authorization Form Granting Access to PHI - Insured Clients (PDF, 3 pages, 52kb)
Authorization Form Granting Access to PHI - Self Funded Clients (PDF, 3 pages, 51kb)
Learn more
Individual Commissions Forms
Get started on becoming an individual and family plan broker
View forms