University of Rhode Island 

Delta Dental PPO Plus Premium w/ DeltaVision 130 Plan
2026-2027 Policy Period Enrollment Form

The enrollment deadline for coverage effective September 1, 2026 has been extended to October 15, 2026. This is the final fall deadline. No enrollment will be accepted after this date.

Enrollment will be processed AFTER the deadline and once processed, coverage will be effective
September 1, 2026 through August 31, 2027. 

TO CONTINUE THE ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW: if you do not have a SSN, please enter all zeroes.