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Enroll now online in a Delta Dental Individual and Family plan.

Payment options for electronic application: automatic monthly payments via credit/debit card or bank withdrawal. Charges will be made within the first five business days of each month.

Please be aware that our online enrollment website does not work in a Safari browser. Please use another browser if you are experiencing issues. We are sorry for any inconvenience this may cause.

**Please note: applications for Delta Dental Individual and Family plans must be received on or before the 25th of the month for coverage to start the first of the following month.**

Download, print and mail in your enrollment form.

Payment for a paper application: yearly payment by check made out to Delta Dental of Kansas with your paper application.

**Please note: applications for Delta Dental Individual and Family plans must be received on or before the 25th of the month for coverage to start the first of the following month.**

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