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Useful Forms for Brokers & Consultants

Find the useful forms to assist you with selling and administering Delta Dental of Oklahoma products and services. PDF forms may be downloaded. Get Adobe Acrobat


Request for Proposal Form (10+ Employees):

  1. Request for Proposal
     View Request for Proposal PDF


Our Products

Small Business Programs (2-9 Employees):

  1. Delta Dental PPO & PPO Plus
     View PPO & PPO Plus PDF
     View PPO & PPO Plus Summary of Benefits PDF

Small Business Forms:

  1. Application for Contract - Small Business
     View Application PDF
  2. Employee Enrollment Form
     View Enrollment PDF
  3. Small Group Checklist
     View Checklist PDF

Employer Sponsored Programs (10+ Employees):

  1. Delta Dental PPO
     View PPO PDF
  2. Delta Dental PPO Plus
     View PPO Plus PDF
  3. Delta Dental Premier
     View Premier PDF
  4. Delta Dental PPO - Point of Service
     View PPO-POS PDF
  5. Dual Options
     View Dual Option PDF
  6. Delta's Choice
     View Choice PDF

    Voluntary (10+ Employees):

  1. Delta Dental PPO-Point of Service - Voluntary
     View PPO-POS-Vol PDF
  2. Delta's Choice-Voluntary
     View Choice-Vol PDF

Employer Sponsored/Voluntary Forms (10+ Employees)

  1. Application for Group Contract
     View Group Contract Application PDF
  2. Employee Enrollment Form
     View Enrollment PDF
  3. (10+) Application Checklist
     View Application PDF
  4. (10+) Request for Proposal Checklist
     View Checklist PDF

Retiree Conversion Program

Retiree benefits are becoming more important as baby boomers enter retirement. Delta Dental provides you a way to offer retiree dental benefits to your employees at no cost or administration to your group.

  • If an employee is currently enrolled in your dental plan and retires from your company, simply provide them with the attached paperwork to submit to our offices within 30 days of leaving your employment.
  • DDOK will permit them to convert to an individual retiree dental policy.
  • Dependents of the retiree must be enrolled at that time.
  • Payments are made monthly via a DDOK draft from the retirees checking or savings account or one-time payment for the calendar year.
  • Rate adjustments, if necessary, occur January of each year.


    •  View Retiree Overview PDF

     View Retiree Conversion Form PDF

    Additional Program Options

    Web Links:

    EyeMed Summary:

    Business Forms:

    Compliance:

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