Forms

VADA’s Insurance Division offers its members group insurance coverage through several different carriers. For efficient processing, we use a single form for all insurance issues. We have combined Medical, Life, Dental, and Short-term Disability, on one application.

Please refer to “Instructions for the VADA Enrollment/Change Form” when processing the Enrollment Form. These instructions will also notify you if additional forms are required.
All forms should be completed and returned to:

VADA Insurance Trust
317 River Street, Suite 2
Montpelier, VT 05602

Please click on the appropriate form from the listing BELOW.

• VADA Insurance Enrollment/Change Form *
• VADA Insurance Termination Form *
• Instructions for Applications *
• Prescription Drug Reimbursement Form
• Short-Term Disability Form
• Spouse Employment Change Form *
• Insurance
  Waiver Form *

* Requires free Adobe Acrobat Reader