Notice
On Friday, March 31, 2023: Customer Service hours will be 9:45 AM - 4:30 PM ET. We apologize for any inconvenience this may cause.
To view benefit information and claim status, self-service by signing into your account or using our Interactive Voice Response System (IVR) 24/7 at 800-452-9310.31
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.
