• Dashboard
  • Edit Page

Menu

Close Navigation
  • Large Group
    • Vision Plans
    • Smile Perks Member Discount Program
    • What's Needed to Quote
  • Small Group
    • Dental Plans
    • Vision Plans
    • Smile Perks Member Discount Program
    • Benefits Guide
    • What's Needed to Quote
  • Find a Provider
    • Dental
    • Vision
  • Your Health
  • About Us
    • About Delta Dental of Illinois
    • Our Foundation
    • Social Impact
    • Careers
    • Contact Us
  • Resources
    • Administrative Guide
    • DeltaVision®
    • Dental Plan Features
    • Group Forms
    • Member Forms
  • Contact Us
  • Sign in
  • Search

I am a ...

Close
  • Individuals & Members
  • Employers & Groups
  • Brokers
  • Dentists
  • Individuals & Members
  • Employers & Groups
  • Brokers
  • Dentists
  • I am a
  • Select State
  • Contact Us
  • Sign in
Delta Dental of Illinois
 MENU
  • Large Group
    • Vision Plans
    • Smile Perks Member Discount Program
    • What's Needed to Quote
  • Small Group
    • Dental Plans
    • Vision Plans
    • Smile Perks Member Discount Program
    • Benefits Guide
    • What's Needed to Quote
  • Find a Provider
    • Dental
    • Vision
  • Your Health
  • About Us
    • About Delta Dental of Illinois
    • Our Foundation
    • Social Impact
    • Careers
    • Contact Us
  • Resources
    • Administrative Guide
    • DeltaVision®
    • Dental Plan Features
    • Group Forms
    • Member Forms
  • Search

Search
Employers & Groups / Resources / Group Forms

Group Forms

Note: You may need to download the form with Adobe or another PDF reader if you'd like to fill in the form electronically on a computer or other digital device.

Large Groups (more than 150 eligible employees)

  • Group Application with Dental and Vision

Small Groups (2-150 eligible employees)

  • Small Group Application with Dental and Vision

Enrollment/Change of Status Forms for Group/Employer

  • Enrollment/Change of Status Form for Group/Employer Dental Policy
  • Enrollment/Change of Status Form for Group/Employer Dental Policy (Spanish version)

Billing

  • ACH Fully Insured Billing Form
  • ACH Self-Funded Billing Form

Member Forms

  • Delta Dental of Illinois Member Forms

Employers & Groups

  • Large Group
    • Vision Plans
    • Smile Perks Member Discount Program
    • What's Needed to Quote
  • Small Group
    • Dental Plans
    • Vision Plans
    • Smile Perks Member Discount Program
    • Benefits Guide
    • What's Needed to Quote
  • Resources
    • Administrative Guide
    • DeltaVision®
    • Dental Plan Features
    • Group Forms
    • Member Forms

Delta Dental of Illinois' Employer Connection

Get Started

Company Info

  • About Delta Dental of Illinois
  • Contact Us
  • Careers
  • Social Impact
  • Delta Dental of Illinois Foundation
  • DeltaVision
  • Leave Us a Review!

Resources

  • Your Health
  • Blog
  • Member Forms
  • Virtual Dentist Visits
  • Smile Perks
  • Information in Other Languages

Helpful Links

  • Find a Dentist
  • Find a Vision Provider
  • Get a Plan
  • Submit a Claim
  • Appeal a Claim
  • Submit a Grievance
  • Submit a Fraud Complaint

Looking for a different Delta Dental member company?

Copyright © 2025 Delta Dental of Illinois. All Rights Reserved.

  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Instagram

Non-Discrimination Notice | Social Media Disclaimer | Privacy Notice |

Website Terms and Conditions |

Website Privacy Policy

Delta Dental of Illinois is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.

Delta Dental of Illinois complies with all applicable Federal and State civil rights laws. Delta Dental of Illinois does not discriminate, exclude people, or treat them differently on the basis of gender, sex (which includes discrimination on the basis of sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity or expression; and sex stereotypes), race, color, religious creed, national origin, citizenship, age, physical or intellectual disability, protected veteran status, marital status, genetic information, or any other characteristic protected by law.

Delta Dental of Illinois uses cookies on this site. Unless you click "Reject Optional Cookies" you are agreeing to the continued collection, storage, and use of cookies and similar technologies on this specific property, device, and browser. Selecting "Reject Optional Cookies" will only set the cookies we deem strictly necessary. Website users cannot opt out of cookies we have deemed strictly necessary. Please visit our Website Terms & Conditions, Website Privacy Policy and Privacy Notice for more information.

Accept Reject Optional Cookies