Forms & Documents

Broker Materials

Appointment & Commission

	Broker-Agency Direct Deposit Authorization Form
	CoPower Producer Agreement CA
	CoPower Producer Agreement NY

Forms

MetLife eCensus Format - All Coverages

Enrollment Forms

Employee

	Benefit Waiver and Declination Form
	CoPower MetLife Dental-Life Disabled Dependent Form
	CoPower SUITE MetLife Beneficiary Designation Form
	MetLife Beneficiary Designation Form
	New Group Enrollment/Waiver Form
	New Group Enrollment/Waiver Form (Spanish)

Employer

	AXA Assistance USA, Inc Service Agreement (only if group is enrolling in Supplemental Life Plan)
	CoPower Census (All Carriers)
	CoPower MetLife Conversion Form
	MetLife Application for Group Insurance
	MetLife DHMO Group Application (only if group is enrolling in DHMO Plan)
	Metlife HIPAA Request Form
	MetLife Specialty Market Submission Form
	MetLife Statement of Health Form
	W-9 Form

In-Force Group Materials

Employee Forms

	Existing Group Enrollment and Change Form
	Existing Group Enrollment and Change Form (Spanish)
	MetLife Accelerated Benefit Option Form (ABO)

Employer Administration

CoPower Contact Sheet

Employer Forms

	Direct Debit Authorization Form
	Employee Termination Form
	Federal COBRA and CalCOBRA Status Notification Form
	Group Address Change Form
	Group Cancellation Form
	One Time Bank Draft Authorization Form
	Renewal Date Change Request Form

Sales Guides & Flyers

Value Add Programs

	CoPower Vantage Powerful Perks Flyer
	Discount RX Card
	Discount RX Card - Spanish
	Zywave CoPower Flyer

Brochures/Flyers: Broker/Employer

	CoPower Portfolio
	Empower Group Flyer
	MetLife Basic Requirements
	MetLife CA LTD Benefit Summary Workbook
	MetLife Disability
	MetLife PDP Plus Network
	MetLife Preferred Dentist Program
	MetLife Vision

Summary of Benefits (SOB)

Dental HMO: MetLife

	MetLife 5-50 DHMO MET100 Summary of Benefits
	MetLife 5-50 DHMO MET150A Summary of Benefits
	MetLife 5-50 DHMO MET185A Summary of Benefits
	MetLife 5-50 DHMO MET225 Summary of Benefits
	MetLife 5-50 DHMO MET245 Summary of Benefits
	MetLife 5-50 DHMO MET290 Summary of Benefits
	MetLife 5-50 DHMO MET335 Summary of Benefits
	MetLife 5-50 DHMO MET85 Summary of Benefits
	MetLife 5-50 DHMO METCO1C Summary of Benefits
	MetLife 5-50 DHMO METCO2C Summary of Benefits
	MetLife 5-50 DHMO METCO3C Summary of Benefits
	MetLife 5-50 DHMO METCO4C Summary of Benefits
	MetLife 5-50 DHMO METCO5C Summary of Benefits
	MetLife 5-50 DHMO METCO6C Summary of Benefits
	MetLife 5-50 DHMO METCO7C Summary of Benefits
	MetLife 5-50 DHMO METCO8C Summary of Benefits
	Metlife_DHMO.doc

Life: MetLife

	MetLife Life 1x Salary to $100K Summary of Benefits
	MetLife Life 1x Salary to $150K Summary of Benefits
	MetLife Life 1x Salary to $50K Summary of Benefits
	MetLife Life 1x Salary to $75K Summary of Benefits
	MetLife Life 2x Salary to $150K Summary of Benefits
	MetLife Life 2x Salary to $250K Summary of Benefits
	MetLife Life Flat $10K Summary of Benefits
	MetLife Life Flat $15K Summary of Benefits
	MetLife Life Flat $25K Summary of Benefits
	MetLife Life Flat $50K Summary of Benefits
	MetLife Life Supplemental Term Life

Dental PPO: MetLife

	MetLife_DPPO_MAC_Basic_Customizable_Summary
	MetLife_DPPO_MAC_Basic_with_Ortho_Customizable_Summary
	MetLife_DPPO_MAC_Major_Customizable_Summary
	MetLife_DPPO_MAC_Major_with_Ortho_Customizable_Summary
	MetLife_DPPO_Percentile_Basic_Customizable_Summary
	MetLife_DPPO_Percentile_Basic_with_Ortho_Customizable_Summary
	MetLife_DPPO_Percentile_Major_Customizable_Summary
	MetLife_DPPO_Percentile_Major_with_Ortho_Customizable_Summary

Vision: MetLife

	MetLife_Vision_M100D-10-25_2022
	MetLife_Vision_M100D-20-20_2022
	MetLife_Vision_M130A_10-25_2022
	MetLife_Vision_M130D_10-25_2022
	MetLife_Vision_M150D-10-25_2022