Forms
At Delta Dental, we want to make selling our products as simple as possible. We have made available for download important forms to ensure you have everything you need just a click away.
Complete and turn in this form with each new group you submit. This form includes a commission schedule for standard commission levels, and you can also register for direct deposit.
This form must be completed if you enroll members in the Delta Dental Individual Plan. One agreement will cover all individuals enrolled.
In order for Delta Dental of Tennessee to release Protected Health Information to you for one of your clients, you must have your client complete and sign this form.
When an agent or agency writes its first group with Delta Dental of Tennessee, the Agent Fee Agreement –Business Associate Addendum must be signed. If commission is paid to the agency, the form can be completed by the agency with the Tax ID number used. If commission is to be paid to an individual agent, the agent must sign the form using his or her social security number.
Sign up for Direct Deposit (aka Electronic Funds Transfer) to automatically transfer funds from Delta Dental into your checking or savings account.
If the information you are looking for is not available here, contact your Account Manager.