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.
- Subscriber Appeals Form
Use this form to file an appeal of an adverse benefit determination. - Authorized Representative Form for Appeals
Use this form when you have chosen a representative for your appeal. - Full-time Student Dependent Certification Form
Use this form when you have an overage dependent who is a full-time student.
