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General Broker Tools & Resources

Broker Forms
- Authorization to Disclose Information (PDF)
- Broker of Record for Individuals (PDF)
- Broker of Record Letter (PDF)
- 2020 NY Small Group Silver 4 Application (PDF)
- 2020 MVP Spending Account Application (PDF)
Large Group Information
- Together We Grow Brochure (PDF)
- New York Large Group Billing & Contact Form (PDF)
- Enrollment/Change Form—New York Large Group (PDF)
- Enrollment/Change Form—Vermont Group Plans (PDF)
- MVP Core Analytics (PDF)
Small Group Information
- Small Group Management Center Quick Reference Guide (PDF)
- Together We Grow Brochure (PDF)
- New York Small Group Application HMO (PDF)
- Enrollment/Change Form—New York Small Group HMO (PDF)
- New York Small Group Application EPO/PPO (PDF)
- Enrollment/Change Form—New York Small Group EPO/PPO (PDF)
- Vermont Small Group Application (PDF)
- Vermont Group Plan Enrollment Form (PDF)
- New York Small Group Recertification Form (PDF)
- Vermont Small Group Recertification Form (PDF)
- Healthy New York Small Group Application (PDF)
- Healthy New York Recertification Form (PDF)
Individual Information
- Together We Grow Brochure (PDF)
- Enrollment/Change Form—New York Individual (PDF)
- Enrollment/Change Form—Vermont Individual (PDF)
- Dental Enrollment/Change Form – Individual (PDF)
Medicare Individual Broker Information
- Medicare Sales Material Request – To complete this form, please download and save it to your computer. Email completed forms to mvpmedicarebrokers@mvphealthcare.com. Forms cannot be completed in a web browser window.
- Online Enrollment Tool
- Scope of Sales Appointment Confirmation Form
- Authorization to Disclose Information (ADI) Form
- Medicare Part D Comprehensive Formulary
- MVP Medicare Cost Calculator
- Estimate MVP plan prescription prices and out-of-pocket costs
Benefits at a Glance
MVP® Medicare Patriot Plan^SM
- MVP Medicare Patriot Plan with Part D Overview – For residents of the following counties in New York: Albany, Cattaraugus, Chautauqua, Dutchess, Erie, Jefferson, Monroe, Niagara, Oneida, Onondaga, Ontario, Oswego, Rensselaer, Saratoga, Schenectady, Steuben, St. Lawrence, Ulster, and Wayne.
Supplemental Benefit Information
Summary of Benefits
Enrollment Applications
Medicare Employer Group Broker Information

Creditable Coverage

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