Individual & Family Forms
Forms & Documents
Welcome to our Forms and Documents library. Additional forms may be available in the Benefit Manager Toolkit. If you still can't find what you're looking for, please feel free to contact us.
(ACH) Payment Authorization Form
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Individual Authorization to Access PHI Form
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Dental Claim Form
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Mobile App Flyer (English)
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Classic Plan Flyer - Individual & Family
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Individual Plan Brochure
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Teledentistry Flyer
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Mobile App Flyer (Spanish)
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Member Portal Flyer
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Preventive Plan Flyer - Individual & Family
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Family Flex Plan Flyer - Individual & Family
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Clean 13 Plan Flyer - Individual & Family
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Member Forms
Individual Authorization to Access PHI Form
Download PDF
(ACH) Payment Authorization Form
Download PDF
Dental Claim Form
Download PDF
Integrated Voice Response (IVR) Reference Card and Shortcuts for Members
Download PDF
Individual Plan Brochure
Download PDF
Mobile App Flyer (English)
Download PDF
Evidence Based Dentistry w/o PCS Flyer
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Mobile App Flyer (Spanish)
Download PDF
Member Portal Flyer
Download PDF
Teledentistry Flyer
Download PDF
Pre-Treatment Estimate Flyer
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Evidence Based Dentistry w/ PCS Flyer
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Preventive Care Security (PCS) only available on select Dental Plans.
Preventive Care Security (PCS) Flyer
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Preventive Care Security (PCS) only available on select Dental Plans.
Employer Forms
Group Insurance Application Form
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Group Plan Enrollment/Change Form
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Sub Group Application Addendum
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Evidence Based Dentistry w/ PCS Flyer
Download PDF
Preventive Care Security (PCS) only available on select Dental Plans.
Preventive Care Security (PCS) Flyer
Download PDF
Preventive Care Security (PCS) only available on select Dental Plans.
Member Portal Flyer
Download PDF
Integrated Voice Response (IVR) Reference Card and Shortcuts for Members
Download PDF
Clean 13 Plan Flyer - Small Group
Download PDF
Value Plan Flyer - Small Group
Download PDF
Benefit Manager Toolkit (BMT) Flyer
Download PDF
Evidence Based Dentistry w/o PCS Flyer
Download PDF
Teledentistry Flyer
Download PDF
Mobile App Flyer (English)
Download PDF
Mobile App Flyer (Spanish)
Download PDF
PPO vs. Premier (Network) Flyer
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Pre-Treatment Estimate Flyer
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Preventive Plan Flyer - Small Group
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Deluxe Plan Flyer - Small Group
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Ultimate Plan Flyer - Small Group
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Shared Plan Flyer - Small Group
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Broker Forms
Group Insurance Application Form
Download PDF
Group Plan Enrollment/Change Form
Download PDF
Dental Claim Form
Download PDF
ACH Authorization Form
Download PDF
Individual Authorization to Access PHI Form
Download PDF
Sub Group Application Addendum
Download PDF
Broker Individual Plan Sales - Custom URL Application
Complete Form
Custom link for MySmileCoverage.com. Ex. mysmilecoverage.com/nm/your-name-here. Must already be an appointed broker for Delta Dental of New Mexico.
Evidence Based Dentistry w/ PCS Flyer
Download PDF
Preventive Care Security (PCS) only available on select Dental Plans.
Preventive Care Security (PCS) Flyer
Download PDF
Preventive Care Security (PCS) only available on select Dental Plans.
Member Portal Flyer
Download PDF
Benefit Manager Toolkit (BMT) Flyer
Download PDF
Evidence Based Dentistry w/o PCS Flyer
Download PDF
Mobile App Flyer (English)
Download PDF
Mobile App Flyer (Spanish)
Download PDF
Teledentistry Flyer
Download PDF
Integrated Voice Response (IVR) Reference Card and Shortcuts for Members
Download PDF
PPO vs. Premier (Network) Flyer
Download PDF
Pre-Treatment Estimate Flyer
Download PDF
Preventive Plan Flyer - Small Group
Download PDF
Clean 13 Plan Flyer - Small Group
Download PDF
Value Plan Flyer - Small Group
Download PDF
Deluxe Plan Flyer - Small Group
Download PDF
Shared Plan Flyer - Small Group
Download PDF
Ultimate Plan Flyer - Small Group
Download PDF
Provider Forms