For plan information, visit our individual dental insurance page. Please stop all debits or charges for premium payments. Connect with your Delta Dental to learn more. Dental Plans Delta Dental PPOSM - 17228 ... discriminate on the basis of disability and, upon request, will provide reasonable accommodations to ensure equal access to its programs, services and activities. Delta Dental Patient Direct ID cards must be returned to Delta Dental of New Mexico with a written request for the refund postmarked within 45 days of the date your Delta Dental Patient Direct ID cards were mailed to you. Delta Dental is comprised of a national network of 39 independent Delta Dental companies that offer dental benefits in all 50 states and other U.S. territories. I am also requesting written confirmation of the cancellation and the return of any premiums. 2021 Medical/Dental Plan Cancellation Form 1. For Delta Dental Individual and Family Premier, Delta Dental Individual and Family PPO Value for Seniors, Delta Dental Individual and Family EPO and DeltaCare if a subscriber would like to cancel their dental plan they must provide a written letter of intent to cancel 30 days before they wish to cancel to: Delta Dental of Massachusetts P.O. The Delta Dental companies have a variety of dental insurance plans designed for groups and individuals to meet their dental health needs. ... You may request electronically a list of your benefits by submitting the online Customer Service Request for DeltaCare USA. Please consider this letter as a formal request to cancel the referenced dental insurance policy. If we receive your request in writing prior to the 10th of the month we will cancel your policy at the end of that month. Mid-Atlantic States (Delta Dental Delaware, Inc., Delta Dental of the District of Columbia, Delta Dental of New York, Inc., Delta Dental of Pennsylvania (and Maryland), Delta Dental of West Virginia, Inc.) ... (Where we will reply to you about this request) Submit Cancel. Which member company is yours depends on how your dental plan was purchased. The effective date of policy cancellation is DATE. Refund entitlement applies only to individuals enrolling in Delta Dental … Availability varies from state to state, so check with your Delta Dental to see what is … We have dental plans for individuals, families, seniors, aarp members, and costco executive members. For instance, if you request a May 31st termination date, your written request must be received at Delta Dental on or before May 11th. Delta Dental offers individual and family dental insurance plans. Through our national network of Delta Dental companies, we offer dental coverage … Online Enrollment System User Guide. 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