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Dental and Vision Forms

Delta Dental of Iowa offers you and your clients a variety of resources. Below are some common forms that you and your clients may need to access. 

Delta Dental Small Group Forms (1 to 50 employees) 

Delta Dental Large Group Forms (51+ employees)

Delta Dental Individual and Family Plans 

Information on benefits, rates, and brochure for Delta Dental's individual product for retirees, self-employed, students or Iowans that do not have group dental benefits. 

DeltaVision® Forms and Brochures

Vision care plans that combine choice, value and wellness from a name you trust - Delta Dental.

DeltaVision Forms and Applications 

Vision Member Forms 

Agent Forms 

  • Requesting Proposal - Guidelines for requesting quotes for employer groups with 51 or more eligible employees.  

Dental Member Forms and Information

  • Dental Claim Form - Complete if your dentist did not file a claim for your dental treatment
  • Authorization Form - Authorization to release personal health information
  • Personal Representative Form - If you want another person to represent you when making health care decisions 
  • Appeal Form - Information on how to appeal your claim 
  • Virtual Visits - Information on teledentistry visits and how to access services when your dentist is not available. Learn more on emergency visits.