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Delta Dental

Step 1 BENEFITS AND RATES

Review Benefits HMO and PPO

Rates

 

Step 2 APPLICATION

Print application HMO or PPO and complete

or

Complete on-line application

If you select on-line application, this is the final step.


Step 3 PAYMENT METHOD


Print out payment worksheet and complete to determine final monthly payment

There are two options for payment:

  • Auto deduction (Electronic Funds Transfer) directly from your checking account on a monthly basis.
    .
  • Receive a monthly bill and mail in payment.

If you would like auto deduction, please print out the AUTO PAY FORM and complete and prepare a VOID check.

For bill pay please complete a check for the first month's premium, made out to KELSEY NATIONAL (NOT VANTAGE!).

 

Then proceed to next step

 

Step 5 FINAL CHECKLIST AND MAILING

Put the following into an envelope to mail to Vantage:

1. Completed application
2. 1st month's pay OR auto pay form and VOID check
3. Payment Worksheet
4. Copy of childcare license and driver's license

Mail to:

Vantage Business Support & Insurance Services
Attn: Childcare Program
2200 Powell Street Ste 530
Emeryville, CA 94608