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University of Rhode Island 

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


The enrollment deadline has been extended to midnight January 15, 2026.

If you purchase the plan now, your enrollment will be processed AFTER the deadline and once processed, coverage will be effective back to January 1, 2026 through August 31, 2026. 


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

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)