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CoPower Administrator Forms
Ameritas Group Enrollment/Change or Waiver Form
Ameritas Group Enrollment/Change or Waiver Form (Spanish)
Dental Enrollment/Change Form
(for adding new members or making changes to the coverage on any of CoPower’s Delta Dental or DeltaCare policies)
VSP Individual Application
VSP Enrollment/Change Form
(for additions/changes to CoPower’s VSP policies)
VSP Application Census
Termination Form
(for terminations from any of CoPower’s policies)
Group Life Plus $50,000 Employee Application
Group Life Plus $50,001–$250,000 Employee Application
Authorization Agreement for Pre-Arranged Payments
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