| Form Name | Effective Date | Download Form |
|---|---|---|
|
New Group Submission |
||
|
Specialty Business Submission Checklist |
01/01/2020 | Download |
|
Application for Group Insurance - All Lines of Coverage |
09/01/2024 | Download |
|
Application for Group Dental Benefits - DHMO Dental |
01/01/2020 | Download |
|
Specialty Business New Group Submission Form |
01/01/2020 | Download |
|
HIPAA Request Form |
01/01/2020 | Download |
|
Statement of Responsibility |
01/01/2020 | Download |
|
MetLink Customer Authorization Form |
01/01/2020 | Download |
| Form Name | Effective Date | Download Form |
|---|---|---|
|
Enrollment and Change Forms |
||
|
Metlife employee enrollment forms are generated on a group specific basis. Contact your RBG Team for assistance in obtaining enrollment material. |
||
|
Evidence of Insurability Form |
01/01/2020 | Download |
|
Beneficiary Designation Form |
01/01/2020 | Download |
|
Enrollment Census - All Lines |
09/01/2024 | Download |
|
Claim Forms |
||
|
Claim Form - Dental |
01/01/2020 | Download |
|
Claim Form - Vision |
01/01/2020 | Download |
|
Claim Form - Life |
01/01/2020 | Download |
|
Claim Form - STD |
04/01/2020 | Download |
|
Claim Form - LTD Employee Statement |
01/01/2020 | Download |
|
Claim Form - LTD Employer Statement |
01/01/2020 | Download |
|
Attending Physician Statement - LTD/STD Claims |
01/01/2020 | Download |
| Form Name | Effective Date | Download Form | |
|---|---|---|---|
|
Dental PPO, Vision, Life, LTD & STD plan summaries are generated on a group specific basis. Contact your RBG Team with questions. |
|||
|
Dental HMO Benefit Summaries |
|||
|
MET50 |
01/01/2020 | Summary | |
|
MET85 |
01/01/2020 | Summary | |
|
MET100 |
01/01/2020 | Summary | |
|
MET150A |
01/01/2020 | Summary | |
|
MET185 |
01/01/2020 | Summary | |
|
MET185A |
01/01/2020 | Summary | |
|
MET225 |
01/01/2020 | Summary | |
|
MET245 |
01/01/2020 | Summary | |
|
MET290 |
01/01/2020 | Summary | |
|
MET335 |
02/01/2020 | Summary |
| Form Name | Effective Date | Download Form |
|---|---|---|
|
General Information |
||
|
AXA Travel Assistance Services |
09/01/2024 | Download |
|
Broker Standard Commission Agreement |
09/01/2024 | Download |
|
Broker Non-Standard Commission Agreement |
01/01/2020 | Download |
|
Employee Benefit Trends Study 2022 |
04/01/2022 | Download |
|
HIPAA Information - Sample Form & Language |
01/01/2020 | Download |
|
Intermediary and Producer Compensation Notice |
03/01/2020 | Download |
|
EAP Employer Reference Guide - Standard Option |
01/01/2020 | Download |
|
EAP Employer Reference Guide - Enhanced Option |
01/01/2020 | Download |
|
EAP Employer Reference Guide - Premier Option |
01/01/2020 | Download |
|
MetLink Online Service |
01/01/2020 | Download |
|
Dental |
||
|
Find a Provider DHMO |
01/01/2020 | Download |
|
Find a Provider DPPO |
01/01/2020 | Download |
|
Mobile App Brochure |
01/01/2020 | Download |
|
MyBenefits Brochure |
01/01/2020 | Download |
|
MyBenefits Registration |
01/01/2020 | Download |
|
Pre-treatment Estimate Brochure |
01/01/2020 | Download |
|
Vision |
||
|
Eyeconic Employee Flyer |
01/01/2020 | Download |
|
Featured Frame Brands Flyer |
01/01/2020 | Download |
|
Find a Provider Flyer |
01/01/2020 | Download |
|
Mobile App Flyer |
01/01/2020 | Download |
|
MyBenefits Employee Flyer |
01/01/2020 | Download |
|
Vision FAQ Employee Flyer |
01/01/2020 | Download |
|
Vision Network Flyer |
01/01/2020 | Download |
