Healthier employees are more productive employees. Thank you to the Nebraska employers that trust Delta Dental of Nebraska to help keep their employees healthy.
Delta dental of Nebraska provides many forms and resources to help you manage your employer group. Choose from the selections below. Still have questions? Visit our Frequently Asked Questions section or contact us.
- Enrollment Forms
- Enrollment Eligibility/Update Form
- Membership Enrollment Form – Spanish
- 2019 - Enrollment Form for Health Care Reform (Certified Group Products)
- 2018 - Enrollment Form for Health Care Reform (Certified Group Products)
- One Time Load
- Census Enrollment Form
- Benefit Manager Toolkit Resources
- Benefit Manager Toolkit – Guide
- Benefit Manager Toolkit – Overview
- Client Administrator Guide
- Benefit Manager Toolkit Access Form (Client)
- Benefit Manager Toolkit Access Form (Agency)
Billing
- Billing Assistance
- 2019 Weekly Schedule
- 2018 Weekly Schedule
- Direct Debit Authorization Form