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Delta Dental Insurance Company ENROLLMENT/CHANGE FORM Group No. / / / P.O. Box 1809 Alpharetta, GA 300231809 18005212651 www.deltadentalins.com Check One For Employer Use Only Effective Date / Full

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How to fill out dual choice - new:

1. Start by reading the instructions provided with the dual choice - new form to familiarize yourself with the specific requirements and guidelines.
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4. If there are any additional sections or questions on the form, fill them out thoroughly and provide any necessary supporting documentation, if required.
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7. Follow the submission guidelines outlined in the form's instructions. This may include submitting it in person, mailing it, or submitting it electronically, depending on the requirements.

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For pdfFiller’s FAQs

What is dual choice - new?

Dual choice - new is a form that allows employees to choose between two different benefit options.

Who is required to file dual choice - new?

Employers are required to provide the dual choice - new form to employees who are eligible for benefits.

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Employees must carefully review the options provided on the dual choice - new form and select the benefit option that best suits their needs.

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The purpose of dual choice - new is to give employees the opportunity to choose the benefits that are most important to them.

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The dual choice - new form typically requires employees to provide personal information such as name, address, and social security number, as well as information about their selected benefits.

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