DWP Resources & Forms
Delta Dental of Iowa te facilita trabajar con nosotros. Haz clic en los enlaces a continuación para ver el documento que necesites.
DWP Member Forms
- Dental Wellness Plan Member Handbook
- Folleto de beneficios para miembros
- Member Rights and Responsibilities - This describes your rights and responsibilities as a member.
- Dental Wellness Plan Privacy Policy – This describes how health information about you may be used and disclosed and how you can get access to this information.
- Personal Representative Appointment and Authorization to Release Protected Health Information – This form allows Delta Dental of Iowa to disclose protected health information at your request.
- Consentimiento de responsabilidad financiera para el tratamiento: Este consentimiento describe que comprendes que puedes necesitar pagar algún servicio que no esté cubierto por DWP.
- Grievance and Appeal Process – This describes the process to go through if you are not happy about any part of the Dental Wellness Plan.
- Member Complaint Form – This can be used to file an official complaint with DWP.
- Member Appeal Form – This can be used to request an appeal of a benefit decision.
- Exception to Policy Form - This can be used to submit an exception to policy for DWP.
- Preventing fraud, abuse and waste - This can be used to explain ways to prevent fraud, abuse and waste. To learn more, watch an informational video.
- Oral Health Survey