Hamburg Benefit Trust  

Erin Holstein-Treasurer
Julie Maxson-Enrollment
Debra Vertokse-Retirees/COBRA
Katie Klein-Secretary
Amy Takacs-HTA President  
​Please contact trustees for further information.

Evidence of Coverage & Enrollment/Change Form  - click on the button below

Evidence of Coverage

Enrollment/Change Form

Did you know? You can download & use the "Delta Dental Mobile" app in the App Store!

Dental Claim Form

dental_claim_form.pdf
File Size:	54 kb
File Type:	pdf

Download File

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​Delta Dental has added some new products for its members. Here are the 3 flyers that explain them.
Toothpic, BrushSmart, and Virtual Consult are both available to our members as we are a PPO/Premier Plan.

Toothpic Member

Brush Smart

Virtual Consult Member

  You are now able to PRINT an ID card for DELTA DENTAL when you create an account online.

Go to the website, DELTA DENTAL (click)

Click---SIGN IN or REGISTER
Click---Create an Account
(Your Member ID # is your Social Security Number)
After your account is set up, login with it...
On the Left side you should see Hamburg Central Teachers Association, Delta Dental PPO
Below that is Print ID Card or EMail ID Card

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Evidence of Coverage as of 7-1-19

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LASIK/Hearing Aid Services Through Delta

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HIPPA Privacy Notice

privacystatementdocument-hippa.rtf
File Size:	43 kb
File Type:	rtf

Download File

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Changes in eligibility status (i.e. marriage, divorce,birth, etc.) must be reported to the Plan Administrator 
(Julie Maxson) within 31 days following the event causing the change. If you do not change coverage when
first eligible, you may change later during "open enrollment".
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​If you are thinking of retiring and are currently enrolled in the dental program with Delta,
please contact (email) Deb Vertoske as soon as possible.  

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