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About Delta Dental
For Members
For Employers
For Dentists
For Brokers/Consultants
Individual/Family Plans
State Dental Plans
Community Service
Oral Health & Wellness
Secure Email System

Services, Forms & More
 

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

Products We Offer
Retiree Conversion Program
Online Resources Application Form
Hours of Operation & Holiday Schedule
Compliance
 

Products We Offer

Small Business Programs (2-9 Employees):

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

Forms:

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

Employer Sponsored Programs (10+ Employees):

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

    Voluntary (10+ Employees):

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

Additional Program Options

Web Links:

EyeMed Summary:

Forms:

Supplies Request:

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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


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Enroll in Online Resources with E-Bill
Our "Online Resources" system lets us provide you (or a designated person within your company) with access 24/7 to monthly billing invoices, online web payments history, subscriber lists, a printable dentist directory, online eligibility maintenance as well as various useful forms and links. A monthly email containing the current link will notify you when your newest monthly billing invoice is ready to be retrieved. You receive this link on your usual billing day each month. Then, you simply visit our website, enter your User Name and Password (which will be provided by Delta Dental) and retrieve your current bill.

Enroll with E-Bill
 View Application Form
 

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Compliance:


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