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CoPower Forms and Applications
Commonly used forms:
CoPower Administration
Employer Application for Dental & Vision
Employee Termination Form
(for terminations from dental, vision or life products through CoPower)
Direct Debit Authorization Form
Group Address Change Form
Group Cancellation Form
Delta Dental
Dental Enrollment/Change Form
(for adding new members or making changes to the coverage on any of CoPower’s Delta Dental or DeltaCare policies)
Dental Enrollment/Change Form (Spanish)
Delta Dental and VSP Enrollment/List Form
Delta Dental Enrollment/List Form
VSP
VSP Individual Application
VSP Enrollment/Change Form
(for additions/changes to CoPower’s VSP policies)
VSP Enrollment/Change Form (Spanish)
VSP Application Census
(for new group submission only)
Delta Dental and VSP Enrollment/List Form
VSP Waiver Form
Transamerica
CoPower Basic Term Life Enrollment Form
CoPower Basic Term Life Simplified Issue Employee Application ($50,000+)
BeneFLEX COBRA
BeneFLEX Intent to Enroll Form
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