University of Rhode Island 

Delta Dental PPO Plus Premium w/ DeltaVision 130 Plan
2025-2026 Policy Year Enrollment Form

The enrollment deadline has been extended to midnight October 15, 2025. This is the final deadline for fall 2025. Late enrollment will not be accepted.

If you purchase the plan now, your enrollment will be processed AFTER the deadline and once processed, coverage will be effective September 1, 2025 through August 31, 2026. 

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