Get Change Access Administrator Form - Tufts Health Plan

Filling out the Change Access Administrator Form for Tufts Health Plan is a straightforward process that allows brokers to designate an individual as the new access administrator for their account. This guide offers clear, step-by-step instructions to help you complete the form online efficiently.

Follow the steps to complete the Change Access Administrator Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, you will need to provide the Broker Name. Enter the name of the brokerage that is designating the new access administrator.
3. Next, identify the signatory. The individual must print their name and provide their signature, certifying their authority to bind the brokerage in this legal agreement.
4. Indicate the date when the form is being signed. This helps to maintain a chronological record.
5. Fill in the Name of Agency and Tax ID or S.S. Number relevant to the Broker.
6. Provide an Email Address for the individual who is filling out the form to ensure clear communication.
7. Decide who will be the new access administrator. If you choose yourself, check the corresponding box. If you intend to assign another individual, make sure to complete the section for that person.
8. If you choose another individual, print their name, phone number, and email address to ensure they are properly identified.
9. Decide if the new administrator will have access to commissions and bonus information and check the corresponding boxes.
10. Once all sections are completed, review the information for accuracy. Save changes, and prepare to submit the form.
11. Finally, fax the completed form to the Tufts Health Plan Small Group Sales and Service Department or email it to the designated address.

Complete your CHANGE ACCESS ADMINISTRATOR FORM online today to ensure smooth management of your Tufts Health Plan account.