Massachusetts DeltaCare Dental Plan
UMass Worcester - GSBS Only

2017-2018 POLICY YEAR
ENROLLMENT FORM

The enrollment deadline is midnight on 12/15/17.

Please note that if you enroll in the plan now, your coverage will be effective from 1/1/18-8/31/18.


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

To find your ID, go to PeopleSoft, Self Service, Student Center, Personal Information, Demographic Data. You should see your 9-digit ID near the top of the screen.

first name:
last name:
student ID: