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Forms

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Annual Report Form Order a copy of Delta Dental's 2007 Annual Report

	Appeal Form 1A
	Appeal Form 1B
	Authorization for Release of Health and Payment Information
	Claim Form
	Request claim forms in the mail
	Certification of Handicapped Child's Dependency Status
	Change Transmittal Form
	COBRA Aplication
	Coordination of Benefits Form
	Eligibility Enrollment Form
	Plan Sponsor's Certification Form A (PHI not limited to enrollment or summary health information)
	Plan Sponsor's Certification Form A (PHI not limited to enrollment or summary health information)
	Plan Sponsor's Certification Form B (PHI limited to enrollment or summary health information)
	Plan Sponsor's Certification Form B (PHI limited to enrollment or summary health information)
	Request for Change of Member Address
	Student Documentation Verification Form