Represent Delta Dental as a Broker

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): 

Please complete the required forms listed below and return all forms to getappointed@deltadentalnc.com.  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.   Completion of the North Carolina Department of Insurance form is mandatory and your producer appointment will not be processed without this form. 

The following items must be included.

  1. Completed Agency/Agent Agreement with W-9, direct deposit form, and deposit slip or voided check
  2. Signed DDNC Broker Addendum to sell individual products
  3. Signed DDNC Vision Addendum to sell vision products
  4. A copy of your LA&H of A&H license
  5. North Carolina Department of Insurance Application to obtain Lines of Authority for Dental Services and Vision.  (Please note: The Department of Insurance form is mandatory)

Please email all required pages of the agreement to getappointed@deltadentalnc.com.

Or fax all required pages to: 980-312-8243

Questions? Contact us at (800) 587-9514

Download Broker Agreement

To sell our individual product, the below document must be completed.

 

Individual Product Addendum
To sell our GROUP DeltaVision® products, the below document must be completed.

 

Group Vision Addendum

If you're signing the agreement on behalf of your agency: 

If your agency does not have an active agreement with Delta Dental of North Carolina, 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.

If your agency has an active agreement with Delta Dental of North Carolina, a company officer will need to notify us in writing that you are an agent at this agency.

Please provide the completed NCDOI application, a copy of your license, and the completed Add Agent Form signed by an officer of your agency.   Completion of the North Carolina Department of Insurance form is mandatory and your producer appointment will not be processed without this form.  Completed documents can be emailed to getappointed@deltadentalnc.com

 

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:

  1. Completed Agency/Agent Agreement with W-9, direct deposit form, and deposit slip or voided check
  2. Signed DDNC Broker Addendum to sell individual products
  3. Signed DDNC Vision Addendum to sell vision products
  4. A copy of your agency's license
  5. Copies of all the producers’ licenses along with Add Agent Forms
  6. North Carolina Department of Insurance Application to obtain Lines of Authority for Dental Services and Vision. (Please note: The Department of Insurance form is mandatory and must be filled out for EACH producer)

Please email all required pages of the agreement to getappointed@deltadentalnc.com.

Or fax all required pages to: 980-312-8243

Questions? Contact us at (800) 587-9514 

Download Broker Agreement
To sell our individual product, the below document must be completed.

 

Individual Product Addendum
To sell our GROUP DeltaVision® products, the below document must be completed.

 

Group Vision Addendum
The North Carolina Department of Insurance Application

 

NCDOI Application

If you are appointing a new producer at your agency, the below document must be completed. 

Please include these items:

 Add Agent Form

Producer License

The North Carolina Department of Insurance Application that is MANDATORY for EACH producer

Add Agent Form

Have Questions?

Download our FAQ document below.

Download FAQ