DWP Resources & Forms

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DWP Member Forms - English

Dental Wellness Plan Member Handbook
- English
- Español
Member Benefits Flyer
- English
- Español
Member Rights and Responsibilities - This describes your rights and responsibilities as a member.
Dental Wellness Plan Privacy Policy – This describes how health information about you may be used and disclosed and how you can get access to this information.
Personal Representative Appointment and Authorization to Release Protected Health Information – This form allows Delta Dental of Iowa to disclose protected health information at your request.
Financial Responsibility Consent for Treatment – This describes that you understand if you need to pay for any services that are not covered by DWP.
- English
- Español
Grievance and Appeal Process – This describes the process to go through if you are not happy about any part of the Dental Wellness Plan.
Member Complaint Form – This can be used to file an official complaint with DWP.
Member Appeal Form – This can be used to request an appeal of a benefit decision.
Exception to Policy Form - This can be used to submit an exception to policy for DWP.
Preventing fraud, abuse and waste - This can be used to explain ways to prevent fraud, abuse and waste. To learn more, watch an informational video.

Documentos en Español