Notice
Happy Holidays! We are looking forward to a healthy, smile-filled 2025.
Customer Service holiday hours
Dental Forms Library for Employers
Easily download and submit the form or application that relates to your needs.
Authorization Form Granting Access to PHI (PDF, 1 page, 52kb)
Eligibility Enrollment Change Form (PDF, 2 pages, 22kb)
Use this form to submit new adds, changes, and terminations.
Disabled dependent verification certification (PDF, 1 page, 13kb)
This form officially certifies the dependency status of a disabled dependent. To be signed by the child's physician.
Delta Dental of Connecticut is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
