Delta Dental Of North Carolina - Employers

Current Location: Delta Dental Of North Carolina > Employers > Forms & Publications

The following documents can only be viewed by using Acrobat® Reader® software, which can be downloaded free of charge from www.adobe.com.

Membership Enrollment Form
Spanish Membership Enrollment Form
Membership Maintenance Form
Disabled Dependent/Michelle's Law Application
HIPAA Designated Contact Form
Online Enrollment Brochure
Online Enrollment User Request Form*
Group Administration Manual
Agent of Record Assignment Form
Group Master Application
International Emergency and Expatriate Dental Program Claim Form and Instructions for Members
COBRA Premium Subsidy Recap
COBRA Election Form for ARRA (this form is only for groups with less than 20 full-time employees)

* To complete this form, right click on the un-opened Word file and select "Save Target As". This will allow you to save the form to your own files and e-mail it.

Billing Forms & Calendars

Automated ASO ACH Authorization Form
Automated Risk ACH Authorization Form
2010 Weekly Bill Schedule
2010 Monthly Fully Insured (Risk) Schedule
Billing Reports Online Brochure
Billing Reports Online User Request Form
Billing Reports Online Change Request Form