Notice:
If you have questions about your coverage or benefits, please contact Member Services:
Members who have purchased insurance directly through Delta Dental of Massachusetts: 888-899-3734
Members enrolled in a plan through their employer or Massachusetts Health Connector members: 800-872-0500
Delta Dental Claims Forms
Get your claim started by submitting one of the standard forms that relates to your needs.
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Subscriber Appeals Form (PDF)
Use this form to file an appeal of an adverse benefit determination. -
Authorized Representative
Form for Appeals (PDF) Use this form when you have chosen a representative for your appeal. -
Full-time Student Dependent Certification Form (PDF)
Use this form when you have an overage dependent who is a full-time student.
