Forms & Documents

Broker Materials

Appointment & Commission

	Broker-Agency Direct Deposit Authorization Form
	CoPower Producer Agreement CA

Enrollment Forms

Employee

	Benefit Waiver and Declination Form
	Delta Dental DeltaCare Claim Form
	New Group Enrollment/Waiver Form
	New Group Enrollment/Waiver Form (Spanish)
	Unum Beneficiary Designation Form (Spanish)
	Unum Employee Voluntary Life Application
	Unum Evidence of Insurability Form (Spanish)
	Unum Member Voluntary Life Application (Spanish)
	UnumEvidence of Insurability Form

Employer

	CoPower Enrollment Census (All Carriers) - California
	CoPower ONE Employer Application - California
	CoPower ONE Open Enrollment Request Form
	W-9 Form

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)
	Unum Change Request Form - Voluntary Life
	Unum Life Long Term Disability Claim Form
	Unum Life Short Term Disability Claim Form
	Unum Portability Form
	VSP Out-of-Network Reimbursement Form
	VSP Out-of-Network Reimbursement Form (Spanish)

Employer Administration

	CoPower Contact Sheet
	Unum Life & AD&D Claim Form

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
	Unum Notification of Conversion Form

Sales Guides & Flyers

Value Add Programs

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

Product Guides

CoPower ONE Product and Rate Guide 2025 - California

Brochures/Flyers: Broker/Employer

	CoPower ONE Pick One Flyer CA Region 1
	CoPower ONE Pick One Flyer CA Region 2
	CoPower Portfolio
	Delta Dental Cost Estimator Flyer
	Delta Dental PPO - Power of Choice
	Empower Group Flyer

Brochures/Flyers: Member

	Member Perks for Your Smile and Beyond (Spanish)
	7 Ways to Make the Most of Your Dental Plan (PPO + Premier)
	BrushSmart™ transforms your oral health
	Coordinate Two Plans with Dual Coverage
	Cost Estimator
	Delta Dental Coverage While Traveling
	DeltaCare USA 8 Ways to Make the Most of Your Dental Plan
	Get Check-ups Remotely with Virtual Dentistry!
	Get the Facts Straight - Ortho DCU
	Make the Most of Your Dental Plan (PPO)
	Member Perks for Your Smile and Beyond
	PPO + Premier Product Flyer
	Resources at Your Fingertips - Online Tools
	VSP EasyOptions
	VSP Eyeconic
	VSP Eyeconic Save Time and Money
	Where's My ID Card
	Where's My ID Card (Spanish)

Summary of Benefits (SOB)

Dental HMO: Delta Dental

	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 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

Dental PPO: Delta Dental

	CoPower ONE Benefit Highlights Voluntary Plan No Ortho
	CoPower ONE Bronze Plan Highlights w/$100K Life
	CoPower ONE Bronze Plan Highlights w/$150K Life
	CoPower ONE Bronze Plan Highlights w/$15K Life
	CoPower ONE Bronze Plan Highlights w/$35K Life
	CoPower ONE Bronze Plan Highlights w/$50K Life
	CoPower ONE Gold Plan Highlights w/$100K Life
	CoPower ONE Gold Plan Highlights w/$150K Life
	CoPower ONE Gold Plan Highlights w/$20K Life
	CoPower ONE Gold Plan Highlights w/$35K Life
	CoPower ONE Gold Plan Highlights w/$50K Life
	CoPower ONE Highlights Voluntary Plan
	CoPower ONE Platinum Plan Highlights w/$100K Life
	CoPower ONE Platinum Plan Highlights w/$150K Life
	CoPower ONE Platinum Plan Highlights w/$25K Life
	CoPower ONE Platinum Plan Highlights w/$35K Life
	CoPower ONE Platinum Plan Highlights w/$50K Life
	CoPower ONE Silver Plan Highlights w/$100K Life
	CoPower ONE Silver Plan Highlights w/$150K Life
	CoPower ONE Silver Plan Highlights w/$20K Life