Delta Dental Plan Options for Massachusetts Students

TOTAL CHOICE PPO PLAN
2025-2026 Policy Year Enrollment Form

This enrollment form is for the TOTAL CHOICE PLAN. If you meant to enroll in the DeltaCare Dental Plan, please click "Enrollment Form" on the left of this page under the DeltaCare section.

If you purchase the plan now, your coverage will be effective September 1, 2025 through August 31, 2026. The enrollment deadline has been extended to midnight September 10, 2025. Enrollment will be processed AFTER the deadline and coverage will be made effective September 1, 2025.

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.