Forms

General Broker Tools & Resources

• Broker Forms

  General

  • Authorization to Disclose Information (PDF)
  • Broker of Record for Individuals (PDF)
  • Broker of Record Letter (PDF)
  • MVP Spending Account Application (PDF)

  New York

  • NY Small Group Silver 4 Application (PDF)
  • NY Vision Plan Selection Form (PDF)

  Vermont

  • VT Vision Plan Selection Form (PDF)

  
  

• Large Group Information

  
  

• Small Group Information

  
  

• Individual Information

  
  

• Medicare Individual Broker Information

  
  

• Medicare Employer Group Broker Information