We understand. Happens to the best of us!
If you have previously given us your email address, enter it below and we will send a login reset link to that address.
If you have not yet provided an email address for your account, use the alternative reset method
Password problems and no email on record with us?
We can still reset your account for you.
What kind of account do you have with us?
Click the links below to view an individual form, or click Full Enrollment Kit to view all forms at once. Forms are in .PDF format which you can print with Acrobat Reader.
Delta Dental Voluntary Premier and PPO Plans (These plans do not meet EHB Pediatric Dental requirement) Full Enrollment Kit New Submission Checklist Membership Application Employer Enrollment Form Enrollment Form Pre-Authorized Checking Application
(These plans do not meet EHB Pediatric Dental requirement) Full Individual Enrollment Kit Enrollment Form for adding dependents