Employer Forms
Delta Dental of Minnesota provides several forms and resources to help you manage your employer group. Choose from the options below! Have questions? Please visit our Frequently Asked Questions section or contact us.
- Enrollment and Maintenance Forms
- Direct Debit Authorization (ACH) Form
- MN/ND Eligibility Enrollment/Update Form
- MN/ ND Enrollment Form for Health Care Reform – Certified Group
- MN/ ND Membership Enrollment Form – Spanish (Small Group Pooled)
- Disabled Dependent/Michelle’s Law Application
- HIPAA Designated Contact Form
- Small business dental employer applications
- MN Dental Employer application – small business
- MN Health Care Reform Employer application
- ND Dental Employer application – small business
- Small business vision employer applications
- DeltaVision® Employer application
- DeltaVision® Enrollment/Eligibility Update form
- DeltaVision® Enrollment/Eligibility Update form - Español
- Agent Forms
- Agent of Record Assignment Form Individuals
- Agent of Record Assignment Form Groups
- ACH Commission Agreement
- Employer Services Portal Access Forms
- Employer Services Portal – Client Access
- Employer Services Portal – Broker Access
- Employer Request and Claim Forms
- Attending Dentists Statement Claim Form
- Additional Resources
- Health Care Reform Resources