Plan document library
Plan summaries and rates, and group application forms in downloadable .PDF format.
Voluntary group plans
2022 plans
2023 plans
Voluntary group plans
Group application form [9050, 9060 & 9070]
Fillable group application form for voluntary group plans 9050, 9060 & 9070
Voluntary group plans
Group application form [602 & 603]
Fillable group application form for ACA group plans 602 & 603
Enrollment change form
Make changes to your group's enrollment roster of primary members and dependents.
Qualifying event form
Notify us of a change in coverage status for an an enrolled primary member or dependent.
Electronic Funds Transfer form
Set up an automatic funds transfer to auto-pay your monthly invoice.
2022 plans
2023 plans
Pooled group plans
Group application form
Fillable group application form for all pooled group plans [9000, 9010, 9020, 2500 & 2525]
Enrollment change form
Make changes to your group's enrollment roster of primary members and dependents.
Qualifying event form
Notify us of a change in coverage status for an an enrolled primary member or dependent.
Electronic Funds Transfer form
Set up an automatic funds transfer to auto-pay your monthly invoice.
2022 plans
SD Retailers Association plans
SDRA plans [8010, 8012, 8013 & 8015]
Overview of benefits and rates for 2022
2023 plans
SD Retailers Association plans
SDRA plans [8010, 8012, 8013 & 8015]
Overview of benefits and rates for 2023
SD Retailers Association plans
Group application form
Fillable group application form for all SDRA group plans [8010, 8012, 8013 & 8015]
Enrollment change form
Make changes to your group's enrollment roster of primary members and dependents.
Qualifying event form
Notify us of a change in coverage status for an an enrolled primary member or dependent.
Electronic Funds Transfer form
Set up an automatic funds transfer to auto-pay your monthly invoice.
Individual & family plans
Individual & Family Plans [1040, 502 & 503]
Summary of benefits and rates for 2022
Individual & family plans
Enrollment form
Fillable enrollment form for all Individual & family plans [1040, 502 & 503]
Individual & family plans
Individual Electronic Funds Transfer (EFT) form
Update your bank account information for auto-payments for your indivdidual/family plan with this EFT form.
Plan features & options
Top 10 advantages
The top 10 reasons to choose a plan from Delta Dental of South Dakota
Plan features & options
Prevention Pays flyer for members
A flyer for members describing the Prevention Pays plan feature.
Plan features & options
Prevention Pays flyer for brokers
A flyer for brokers and consultants describing the Prevention Pays plan feature.
Plan features & options
Prevention Pays flyer for employers
A flyer for employers, group plan administrators, and human resources managers describing the Prevention Pays plan feature.
Plan features & options
Health through Oral Wellness flyer for brokers & employers
A flyer for brokers, employers, group plan administrators, and human resources managers describing the Health through Oral Wellness program.
Plan features & options
Health through Oral Wellness flyer for members
A flyer for members describing the Health through Oral Wellness program.
