Enrollment Forms

Two ways your employees can enroll:

Complete an enrollment form online (PDF), print it and sign it. Then, submit it to your company's human resources department for review and submission to Delta Dental for processing. 

Download an enrollment form (PDF), print it, manually complete and sign the form. Then submit the form to your company's Human Resources department for review and submission to Delta Dental for processing. 

Benefits Administrators:

Once you have reviewed the enrollment form, please mail or fax it to the attention of your assigned Delta Dental group accounts representative. 

Delta Dental of Missouri 
c/o Group Accounts 
P.O. Box 8690 
St. Louis, MO 63126-0690 

If you don't have the fax number of your assigned group accounts representative, you may fax the enrollment form to the number below. 

FAX: 314-656-2881