Forms & Documents

Broker Materials

Appointment & Commission

	Broker-Agency Direct Deposit Authorization Form
	CoPower Producer Agreement CA
	CoPower Producer Agreement NY

Enrollment Forms

Employee

	Benefit Waiver and Declination Form
	Delta Dental DeltaCare Claim Form
	New Group Enrollment/Waiver Form
	New Group Enrollment/Waiver Form (Spanish)

Employer

	CoPower Enrollment Census (All Carriers) - California
	CoPower SELECT Employer Application with Delta Dental, VSP, UNUM, & Landmark
	W-9 Form

In-Force Group Materials

Employee Forms

	Delta Dental HIPAA Authorization
	Delta Dental PPO Claim Form
	Existing Group Enrollment and Change Form

Employer Administration

CoPower Contact Sheet

Employer Forms

	Direct Debit Authorization Form
	Employee Termination Form
	Federal COBRA and CalCOBRA Status Notification Form
	Group Address Change Form
	Group Cancellation Form
	One Time Bank Draft Authorization Form
	Renewal Date Change Request Form

Sales Guides & Flyers

Value Add Programs

	CoPower Vantage Powerful Perks Flyer
	Discount RX Card
	Discount RX Card - Spanish
	Zywave CoPower Flyer

Product Guides

	2025 Delta Dental Small Business Plans CA Brochure
	CoPower ONE Product and Rate Guide 2025 - California
	CoPower Select Delta Dental Choice Summary of Benefits & Rate Guide 2025

Brochures/Flyers: Broker/Employer

	CoPower ONE Pick One Flyer CA Region 1
	CoPower ONE Pick One Flyer CA Region 2
	CoPower Portfolio
	Delta Dental Cost Estimator Flyer
	Delta Dental Dual Coverage Flyer
	Delta Dental PPO - Power of Choice
	Empower Group Flyer

Brochures/Flyers: Member

	Member Perks for Your Smile and Beyond (Spanish)
	7 Ways to Make the Most of Your Dental Plan (PPO + Premier)
	BrushSmart™ transforms your oral health
	Coordinate Two Plans with Dual Coverage
	Cost Estimator
	Delta Dental Coverage While Traveling
	DeltaCare USA 8 Ways to Make the Most of Your Dental Plan
	Get Check-ups Remotely with Virtual Dentistry!
	Get the Facts Straight - Ortho DCU
	Make the Most of Your Dental Plan (PPO)
	Member Perks for Your Smile and Beyond
	PPO + Premier Product Flyer
	Resources at Your Fingertips - Online Tools
	Where's My ID Card
	Where's My ID Card (Spanish)

Summary of Benefits (SOB)

Dental HMO: Delta Dental

	DHMO Advantage 15B SOB
	DHMO Core 17B SOB
	DHMO Deluxe 11A SOB

Dental PPO w/Ortho: Delta Dental

	Choice PPO $1,000 with Ortho Plan Highlights
	Choice PPO $1,000 without Ortho Plan Highlights
	Choice PPO $1,500 with Ortho Plan Highlights
	Choice PPO $2,000 with Ortho Plan Highlights
	Choice PPO $2,000 without Ortho Plan Highlights
	Choice Premier $1,000 with Ortho Evidence of Coverage
	Choice Premier $1,000 with Ortho Evidence of Coverage
	Choice Premier $1,000 with Ortho Plan Highlights
	Choice Premier $1,500 with Ortho Evidence of Coverage
	Choice Premier $1,500 with Ortho Evidence of Coverage
	Choice Premier $1,500 with Ortho Plan Highlights
	Choice Premier $2,000 with Ortho Evidence of Coverage
	Choice Premier $2,000 with Ortho Evidence of Coverage
	Choice Premier $2,000 with Ortho Plan Highlights
	PPO Advantage 400 | $1000 Max | $1000 Ortho SOB
	PPO Advantage 400 | $1000 Max | $1500 Ortho SOB
	PPO Advantage 400 | $1000 Max | D&P Max Waiver | $1000 Ortho SOB
	PPO Advantage 400 | $1000 Max | D&P Max Waiver | $1500 Ortho SOB
	PPO Advantage 400 | $1500 Max | $1000 Ortho SOB
	PPO Advantage 400 | $1500 Max | $1500 Ortho SOB
	PPO Advantage 400 | $1500 Max | D&P Max Waiver | $1000 Ortho SOB
	PPO Advantage 400 | $1500 Max | D&P Max Waiver | $1500 Ortho SOB
	PPO Advantage 400 | $2000 Max | $1000 Ortho SOB
	PPO Advantage 400 | $2000 Max | $1500 Ortho SOB
	PPO Advantage 400 | $2000 Max | D&P Max Waiver | $1000 Ortho SOB
	PPO Advantage 400 | $2000 Max | D&P Max Waiver | $1500 Ortho SOB
	PPO Advantage 400 | $2500 Max | $1000 Ortho SOB
	PPO Advantage 400 | $2500 Max | $1500 Ortho SOB
	PPO Advantage 400 | $2500 Max | D&P Max Waiver | $1000 Ortho SOB
	PPO Advantage 400 | $2500 Max | D&P Max Waiver | $1500 Ortho SOB
	PPO Advantage 400 Voluntary | $1000 Max | $1000 Ortho SOB
	PPO Advantage 400 Voluntary | $1000 Max | $1500 Ortho SOB
	PPO Advantage 400 Voluntary | $1500 Max | $1000 Ortho SOB
	PPO Advantage 400 Voluntary | $1500 Max | $1500 Ortho SOB
	PPO Advantage 400 Voluntary | $2000 Max | $1000 Ortho SOB
	PPO Advantage 400 Voluntary | $2000 Max | $1500 Ortho SOB
	PPO Advantage 400 Voluntary | $2500 Max | $1000 Ortho SOB
	PPO Advantage 400 Voluntary | $2500 Max | $1500 Ortho SOB
	PPO Deluxe 300 | $1500 Max | $1500 Child and Adult Ortho SOB
	PPO Deluxe 300 | $1500 Max | $1500 Child and Adult Ortho SOB
	PPO Deluxe 300 | $1500 Max | $1500 Child Ortho SOB
	PPO Deluxe 300 | $1500 Max | $1500 Child Ortho SOB
	PPO Deluxe 300 | $1500 Max | D&P Max Waiver | $1500 Child and Adult Ortho SOB
	PPO Deluxe 300 | $1500 Max | D&P Max Waiver | $1500 Child Ortho SOB
	PPO Deluxe 300 | $2000 Max | $1500 Child and Adult Ortho SOB
	PPO Deluxe 300 | $2000 Max | $1500 Child Ortho SOB
	PPO Deluxe 300 | $2000 Max | D&P Max Waiver | $1500 Child and Adult Ortho SOB