Becoming a broker for Delta Dental of North Carolina is quick and easy!
Are you an independent agent, or are you affiliated with an agency? Choose your category below.
Becoming a broker for Delta Dental of North Carolina is quick and easy!
Are you an independent agent, or are you affiliated with an agency? Choose your category below.
For individual agents (not associated with an agency):
First, fill out the following form and fax it to us along with a copy of your current LA&H or A&H license. Please note, the Department of Insurance form is mandatory. Once we receive your documents, we will file them for you with the North Carolina Department of Insurance, and we’ll even pay your initial and renewal appointment fees, if applicable.
Please complete and sign the Broker Agreement below using your name, address, phone number, and fax number for commission payments. As an independent agent, you do not have to complete the Agency Contact page. The following items must be included:
Please email all pages of the agreement to your Delta Dental Representative for processing if applicable or email to specialservices@deltadentalmi.com if not currently working with a representative.
Questions? Contact us at (800) 587-9514.
In order to sell our individual product, the below document must also be completed.
If you're signing the agreement on behalf of your agency:
If your agency has an active agreement with Delta Dental, a company officer will need to notify us in writing that you are an agent at this agency. Please provide your start date, a copy of your license, and your Social Security number. If your agency does not have an active agreement with Delta Dental, please have an officer (or another employee with the authority to bind the agency) sign the agreement. The agreement is with the agency rather than individual agents, which is why an authorized person must sign it.
Once we receive your documents, we will file them for you with the North Carolina Department of Insurance, and we'll even pay your initial and renewal appointment fees, if applicable. The following documents must be included:
Please email all pages of the agreement to your Delta Dental Representative for processing if applicable or email to specialservices@deltadentalmi.com if not currently working with a representative.
Questions? Contact us at (800) 587-9514.
In order to sell our individual product, the below document must also be completed.
Copyright © 2011–2022 Delta Dental of North Carolina | All Rights Reserved | 4242 Six Forks Road, Suite 970, Raleigh, NC 27609 | (800) 587-9514
The information provided on this site is for general education purposes only and is not intended as a diagnosis, treatment, or a substitute for professional medical or dental advice, diagnosis, or treatment. Consult your dentist or physician for information or treatment specific to you and your health.
Delta Dental of North Carolina is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
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