Employers

Forms and Resources


We've included some of the standard forms you'll need to manage benefits for your employees. Please download the necessary form(s) and return to:

Delta Dental of Rhode Island
PO Box 1517
Providence, RI 02901-1517

Online Enrollment System User Guide

Dental Automatic Payment Form
Direct Electronic Access Agreement * (Return completed form to your Account Executive)
Claim Form
Student Certification Form (Use this form to certify dependents as college students)
Student Certification Form for State of Rhode Island Employees (To be used for State of Rhode Island Employees only)
Group Data Form
Authorization To Release Protected Health Information
Certificate Of Coverage For Small Businesses
Small Employer Territory Map

* Please note: It takes approximately two weeks to process a complete Direct Electronic Access Agreement. Until you receive your username and password, please forward subscriber changes and additions directly to the enrollment department via fax at 401-752-6040.