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Delta
Dental cannot give Protected Health Information over
the phone to a broker after April 14, 2003 without
written authorization.
Employers can authorize their brokers to receive
PHI on their behalf for plan administration activities
by using the following forms:
- Employer Authorization Form A - PHI not limited
to enrollment or summary health information
 PDF
Format
 Word
Format
- Employer Authorization Form B - PHI limited to
enrollment or summary health information
PDF
Format
Word
Format
Individuals can authorize brokers, employers, or
others to receive PHI by using the following
form:
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