Priority Health Pediatric Dental Plans

2023 pediatric dental forms

• Client Information Form (Pediatric Only)
• Eligibility Enrollment/Update Form
• Pediatric EHB Certified Dental Plans (Plans A and B)
  • Pediatric EHB Certified High Plan (Plan A) Summary
  • Pediatric EHB Certified Low Plan (Plan B) Summary

Implementing a group

To start the implementation process of your new pediatric dental plan, the following information must be returned to Delta Dental:

• Completed and signed Client Information Form.
• Completed Eligibility Enrollment/Update Form for any members enrolling in the plan.
• A copy of the pediatric dental plan (Plan A or B) that has been accepted.

Please email, fax or mail materials to the following:

Mail:
Delta Dental of Michigan
Attn: Small Market West
PO Box 30416
Lansing, MI 48909

Fax: 517-706-4625 | Email: pediatricdental@deltadentalmi.com

Individual dental plans

Individual plans are available at affordable rates. For individual plan quotes, information and enrollment, click here, or call 800-971-4108 to speak with an individual plan sales representative.