Delta Dental

 

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Partnered with 

To inquire about Delta Dental, please contact our staff.

Benefits they can offer: 

  • Dental (2+)
  • Discount Vision attached with Dental (Information)

All of these will need to be quoted by Delta Dental. Please contact our staff for additional information.

Quote Request Forms:

For quote and rate information for Delta Dental please contact our staff.  Please note it can take 7 to 10 business days to receive quotes back.

Group Ancillary Quote Request Form

New Business Submission forms:

Employer Forms- Group applications vary based on the plan selection.  Please contact our staff.

New Group Submission Checklist

Binder Check Draft

Group Business Associate Agreement

Employee Forms- New Hire, Change of address, change of name, dependent add or removal,  and employee terminations.

Enrollment-Change Form

Printing ID Card

Provider Search:

Please click the below link for an up-to-date provider search.

AOR (Agent of Record) Letter:

Below is a generic AOR to complete on letter head and fill in the parenthesis (i.e. [COMPANY NAME]= ABC Company).  If you have any questions, please contact our staff.  Please submit the completed AOR to ella@stonehill.net for processing.

SHN AOR

The forms posted on this page are for 2017. If you are interested in any forms for previous years or any pre-ACA plan forms please contact our staff.

 

Delta Dental Website: https://www.deltadental.com/Public/index.jsp

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