Delta Dental Of Nebraska - Employers

Current Location: Delta Dental Of Nebraska > Employers > Forms & Publications

The following documents can only be viewed by using Acrobat® Reader® software, which can be downloaded free of charge from www.adobe.com.

Group Administration Manual
Group Master Application
Membership Enrollment Form
Membership Enrollment Form - Spanish
Membership Maintenance Form
Disabled Dependent/Michelle's Law Application
HIPAA Designated Contact Form
Dental Flex Enrollment Form
Online Enrollment Brochure
Online Enrollment User Request Form*
COBRA Premium Subsidy Recap
COBRA Election Form for ARRA (this form is only for groups with less than 20 full-time employees)

* To complete this form, right click on the un-opened Word file and select "Save Target As" . This will allow you to save the form to your own files and e-mail it.

Billing Forms & Calendars

Automated ASO ACH Authorization Form
Automated Risk ACH Authorization Form
2010 Weekly Bill Schedule
2010 Monthly Fully Insured (Risk) Schedule
Online Billing User Request Form
Online Billing User Change Form

Dental Industry News

How Do Dental Benefits Rank?

EmployerUpdate Newsletters

Fall 2009 Issue
Spring 2009 issue
Fall 2007 issue
Spring 2007 issue
Fall 2006 issue