Get Broker Of Record Letter Sample

Filling out the Broker Of Record Letter Sample is an important step in designating an insurance broker for your group plan. This guide will provide clear, step-by-step instructions to help you complete the form effectively and accurately.

Follow the steps to successfully fill out the form online.

1. Click ‘Get Form’ button to access the Broker Of Record Letter Sample and open it in the online editor.
2. Begin by filling out the 'Group name' field with the official name of your group. Ensure that it matches your legal business name.
3. Enter the 'Date of request' in the designated field, indicating the day you are submitting this authorization.
4. Input your 'Group number' and 'Vendor number' as required. These numbers are usually assigned by your insurance company.
5. Fill in the 'NPN number', which is the National Producer Number associated with your broker.
6. Provide both the 'Broker phone number' and 'Broker fax number' so that they can be contacted easily.
7. Enter the 'Group phone number', 'Group fax number', and 'Group e-mail address' accurately for communication purposes.
8. Input the 'Broker e-mail address' to ensure that the broker can receive all relevant correspondence.
9. The next sections require the signatures and printed names of both the group contact and the broker. Make sure these are completed correctly.
10. Add the 'Group contact title' and the 'Broker agency name' to clarify the roles involved.
11. Input the 'Broker commission rate' and select the appropriate 'Method'.
12. Finally, include the name of the 'Kaiser Permanente account executive'.
13. Once all fields are completed, review the form for any errors before you save your changes. You can then download, print, or share the completed document as necessary.

Complete your Broker Of Record Letter Sample online today to ensure efficient processing of your insurance matters.