Delta Dental Plan Options for Massachusetts Students

TOTAL CHOICE PPO PLAN
Spring 2026 Policy Period Enrollment Form

If you purchase the plan now, your coverage will be effective January 1, 2026 through August 31, 2026. The enrollment deadline is midnight December 10, 2025. Enrollment will be processed AFTER the deadline and coverage will be made effective January 1, 2026.

TO CONTINUE THE ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:

If you have a social security number you are required to enter it below. If you are an international student and do not have a social security, please use your student ID and add leading zeros if necessary to make it a 9-digit number.