UNIVERSITY OF DELAWARE

DELTA PREFERRED DENTAL PLAN ENROLLMENT FORM
CONTRACTED GRADUATE STUDENT AND POSTDOCTORAL DENTAL
2018-2019 Academic Year

Coverage Period: 8/15/18 - 8/14/19

ELIGIBILITY: This is a dental plan offered to Contracted Graduate Students and Postdoctoral Fellows attending the University of Delaware. You may purchase this Delta Dental PPO Plan on a voluntary basis. Enrollment in the Student Health Insurance Plan is not required.

DEADLINE & COVERAGE PERIOD: To enroll, you must complete all required information below PRIOR to the deadline of midnight on September 28, 2018, and pay the full premium by credit card. The plan will be effective from 8/15/18 through 8/14/19.

PROCESSING TIME: Once this form is completed, your record should be activated in Delta Dental's system by the plan's effective date OR about 7-10 business days after this form is submitted, whichever is later

ID CARDS: Members of this plan DO NOT RECEIVE ID CARDS. Instead, once active in Delta's system (but no earlier than the plan's effective date), the member can print the claim form and provide it to the dentist's office along with their SSN to be submitted to Delta Dental. International students who do not have an SSN should use their visa number instead. 

PARTICIPATING PROVIDERS: This plan utilizes both the Delta Dental PPO and Delta Dental Premier networks. Both networks have participating providers nationwide and offer discounted fees. You do not need to select a primary care dentist under either network. You will receive the greatest out-of-pocket savings when visiting a Delta Dental PPO network provider. You will receive good value from Delta Dental Premier network dentist, but those services will be subjected to the out-of-network coinsurance level shown on the plan summary and the out-of-network deductible.


This enrollment form is available only to Contracted Graduate Students  and Postdoctoral Fellows. Non-Contracted Graduates and Undergraduate student are not permitted to enroll at this time. 

A new list of eligible UD ID numbers are submitted to University Health Plans periodically. If you are unable to log into the form, please try again in one week. If you continue to have an issue, for longer than a week and have an active eligible contract that was processed more than a week ago, please contact the Office of Graduate & Professional Studies at UD. 

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