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You can enroll online or download the paper application below.
If you enroll online, you can choose to pay monthly or yearly via credit/debit or bank withdrawal. Charges will be made within the first five business days of each month.
If you enroll via paper application, you will need to send a check along with your application in the amount of one year’s premium (you can find these totals on the paper application).
Delta Dental 2025 Individual & FamilyTM Paper Application and Policy
Please note: paper applications must be received on or before the 25th of the month for coverage to start the first of the following month. Your rates are guaranteed for one year.
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