Broker Materials
Broker-Agency Direct Deposit Authorization Form | |
CoPower Producer Agreement CA | |
CoPower Producer Agreement NY |
Enrollment Forms
Benefit Waiver and Declination Form | |
Delta Dental DeltaCare Claim Form | |
New Group Enrollment/Waiver Form | |
New Group Enrollment/Waiver Form (Spanish) |
CoPower Census (All Carriers) | |
CoPower ONE AppBuilder - New York | |
CoPower SELECT Employer Application with Delta Dental, VSP, UNUM, & Landmark | |
W-9 Form |
In-Force Group Materials
Delta Dental HIPAA Authorization | |
Delta Dental PPO Claim Form | |
Existing Group Enrollment and Change Form |
CoPower Contact Sheet |
Sales Guides & Flyers
CoPower Vantage Powerful Perks Flyer | |
Discount RX Card | |
Discount RX Card - Spanish | |
Zywave CoPower Flyer |
2024 Delta Dental Small Business Plans CA Brochure | |
CoPower Select Delta Dental Choice Summary of Benefits & Rate Guide |
CoPower Portfolio | |
Delta Dental Cost Estimator Flyer | |
Delta Dental Dual Coverage Flyer | |
Delta Dental PPO - Power of Choice | |
Empower Group Flyer |
Summary of Benefits (SOB)
DHMO Advantage 15B SOB | |
DHMO Core 17B SOB | |
DHMO Deluxe 11A SOB |