Forms & Documents

In-Force Group Materials

Employee Forms

	Delta Dental PPO Claim Form
	MetLife Accelerated Benefit Option Form (ABO)
	UNUM Change Request Form - Voluntary Life
	UNUM Life Long Term Disability Claim Form
	UNUM Life Short Term Disability Claim Form
	UNUM Portability Form
	UNUM Waiver of Premium Claim Form
	VSP Out-of-Network Reimbursement Form
	Existing Group Enrollment and Change Form
	Existing Group Enrollment and Change Form (Spanish)

Employer Administration

	CoPower Contact Sheet
	UNUM Life & AD&D Claim Form

Employer Forms

	Direct Debit Authorization Form
	Employee Termination Form
	Federal COBRA and CalCOBRA Status Notification Form
	Group Address Change Form
	Group Cancellation Form
	One Time Bank Draft Authorization Form
	Renewal Date Change Request Form
	UNUM Notification of Conversion Form
	VSP Affiliate Census (Use only for existing VSP groups adding the Affiliate program)

Summary of Benefits (SOB)

Life: MetLife

	MetLife Life 1x Salary to $100K Summary of Benefits
	MetLife Life 1x Salary to $150K Summary of Benefits
	MetLife Life 1x Salary to $50K Summary of Benefits
	MetLife Life 1x Salary to $75K Summary of Benefits
	MetLife Life 2x Salary to $150K Summary of Benefits
	MetLife Life 2x Salary to $250K Summary of Benefits
	MetLife Life Flat $10K Summary of Benefits
	MetLife Life Flat $15K Summary of Benefits
	MetLife Life Flat $25K Summary of Benefits
	MetLife Life Flat $50K Summary of Benefits
	MetLife Life Supplemental Term Life

Vision: VSP

CoPower VSP EasyOptions Plan Summary

Sales Guides & Flyers

Brochures/Flyers: Broker/Employer

CoPower SELECT VSP Product and Rate Guide 2024