Notice
Change Healthcare announced a breach of HIPAA privacy and is reaching out to individuals whose personal information may have been compromised. Although this incident does not involve Delta Dental of New Jersey or Connecticut, Change Healthcare is a vendor we used and we are providing this information to help our members who might be affected.
Small Group Forms for Brokers
Easily access and download all the small group forms and applications.
Small Business 2-50 enrolled employees
Easy employer application (PDF, 8 pages, 2,490 KB)
Download our easy group application for 2-50 business
Simple employee enrollment (PDF, 1 page, 204 KB)
Download our easy group enrollment form for 2-50 business
Enrollment spreadsheet (Excel)
Download our easy group enrollment spreadsheet guide for 2-50 business
Delta Dental of Connecticut is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
