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

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

Group & Enrollment

• Claim Form
• Membership Enrollment Form
• Spanish Membership Enrollment Form
• Membership Maintenance Form
• Disabled DependentMichelle's Law Application
• International Emergency and Expatriate Dental Program Claim Form and Instructions for Members
• HIPAA Designated Contact Form
• COBRA Premium Subsidy Recap
• COBRA Election Form for ARRA (this form is only for groups with less than 20 full-time employees)

Producer Forms

• Agent of Record Assignment Form
• Group Master Application (Pooled Programs)
• Online Commission Reports User Request Form
• Online Commission Reports Help
• Producer Rate Calculator User Request Form
• ACH Commission Form

PLEASE NOTE: Delta Dental of North Carolina accepts standard ADA claim forms. 

© Delta Dental Of North Carolina. All Rights Reserved.