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