Forms & Documents

Broker Materials

Appointment & Commission

	Broker-Agency Direct Deposit Authorization Form
	CoPower Producer Agreement CA
	CoPower Producer Agreement NY

Enrollment Forms

Employee

	Benefit Waiver and Declination Form
	CoPower MetLife Dental-Life Disabled Dependent Form
	CoPower SUITE MetLife Beneficiary Designation Form
	Declaration of Disability Over-Age Dependent Child Form
	Delta Dental DeltaCare Claim Form
	MetLife Beneficiary Designation Form
	New Group Enrollment/Waiver Form
	New Group Enrollment/Waiver Form (Spanish)
	UNUM Beneficiary Designation Form
	UNUM Beneficiary Designation Form (Spanish)
	UNUM Employee Voluntary Life Application
	UNUM Evidence of Insurability Form
	UNUM Evidence of Insurability Form (Spanish)
	UNUM Member Voluntary Life Application (Spanish)

Employer

	CoPower ONE AppBuilder - New York
	MetLife Application for Group Insurance
	AXA Assistance USA, Inc Service Agreement (only if group is enrolling in Supplemental Life Plan)
	CoPower Census (All Carriers)
	CoPower MetLife Conversion Form
	CoPower ONE Employer Application - California
	CoPower ONE Open Enrollment Request Form
	MetLife DHMO Group Application (only if group is enrolling in DHMO Plan)
	Metlife HIPAA Request Form
	MetLife Statement of Health Form
	MetLife Specialty Market Submission Form
	W-9 Form

In-Force Group Materials

Employee Forms

Delta Dental HIPAA Authorization

Sales Guides & Flyers

Brochures/Flyers: Broker/Employer

CoPower SELECT VSP Product and Rate Guide 2024

Summary of Benefits (SOB)

Vision: VSP

CoPower VSP EasyOptions Plan Summary