Forms & Documents

In-Force Group Materials

Employee Forms

	Delta Dental HIPAA Authorization
	Delta Dental PPO Claim Form
	Existing Group Enrollment and Change Form
	Existing Group Enrollment and Change Form (Spanish)
	MetLife Accelerated Benefit Option Form (ABO)
	Unum Change Request Form - Voluntary Life
	Unum Life Long Term Disability Claim Form
	Unum Life Short Term Disability Claim Form
	Unum Portability Form
	Unum Waiver of Premium Claim Form
	VSP Out-of-Network Reimbursement Form
	VSP Out-of-Network Reimbursement Form (Spanish)

Summary of Benefits (SOB)

Dental HMO: Delta Dental

	CoPower ONE DeltaCare Best Plan Highlights w/$100K Life - New York
	CoPower ONE DeltaCare Best Plan Highlights w/$150K Life - New York
	CoPower ONE DeltaCare Best Plan Highlights w/$25K Life - New York
	CoPower ONE DeltaCare Best Plan Highlights w/$35K Life - New York
	CoPower ONE DeltaCare Best Plan Highlights w/$50K Life - New York
	CoPower ONE DeltaCare Better Plan Highlights w/$100K Life - New York
	CoPower ONE DeltaCare Better Plan Highlights w/$150K Life - New York
	CoPower ONE DeltaCare Better Plan Highlights w/$20K Life - New York
	CoPower ONE DeltaCare Better Plan Highlights w/$35K Life - New York
	CoPower ONE DeltaCare Better Plan Highlights w/$50K Life - New York
	CoPower ONE DeltaCare Bronze Plan Highlights w/$100K Life
	CoPower ONE DeltaCare Bronze Plan Highlights w/$150K Life
	CoPower ONE DeltaCare Bronze Plan Highlights w/$15K Life
	CoPower ONE DeltaCare Bronze Plan Highlights w/$35K Life
	CoPower ONE DeltaCare Bronze Plan Highlights w/$50K Life
	CoPower ONE DeltaCare Good Plan Highlights w/$100K Life - New York
	CoPower ONE DeltaCare Good Plan Highlights w/$150K Life - New York
	CoPower ONE DeltaCare Good Plan Highlights w/$15K Life - New York
	CoPower ONE DeltaCare Good Plan Highlights w/$35K Life - New York
	CoPower ONE DeltaCare Good Plan Highlights w/$50K Life - New York
	CoPower ONE DeltaCare Platinum Plan Highlights w/$100K Life
	CoPower ONE DeltaCare Platinum Plan Highlights w/$150K Life
	CoPower ONE DeltaCare Platinum Plan Highlights w/$25K Life
	CoPower ONE DeltaCare Platinum Plan Highlights w/$35K Life
	CoPower ONE DeltaCare Platinum Plan Highlights w/$50K Life
	CoPower ONE DeltaCare Silver/Gold Plan Highlights w/$100K Life
	CoPower ONE DeltaCare Silver/Gold Plan Highlights w/$150K Life
	CoPower ONE DeltaCare Silver/Gold Plan Highlights w/$20K Life
	CoPower ONE DeltaCare Silver/Gold Plan Highlights w/$35K Life
	CoPower ONE DeltaCare Silver/Gold Plan Highlights w/$50K Life
	CoPower ONE DeltaCare Voluntary Highlights
	CoPower ONE DeltaCare Voluntary Highlights - New York
	CoPower ONE DeltaCare Voluntary Plan Highlights - New York
	DHMO Advantage 15B SOB
	DHMO Core 17B SOB
	DHMO Deluxe 11A SOB

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