Vermont Vehicle and Automotive Distributors Association
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Forms & Guidelines

VADA’s Insurance Trust offers its members group insurance coverage through several different carriers. For efficient processing, we use a single form for all enrollment issues. We have combined Medical, Life, Dental, and Short-term Disability, on one application. A Termination/Cancellation form is used to terminate an employee’s coverage or if an employee would like to voluntarily cancel their coverage.

Please refer to page 1 of the Group Enrollment /Change Form for instructions when completing 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
PO Box 747
​Montpelier, VT 05601


Faxed: (802) 461-2659 or emailed to Kim Gauthier at [email protected].
​​
Find a link below for forms and guidelines:
  • 2025 Health Plan
  • 2025 Rate Sheet
  • Group Enrollment/Change Form
  • Termination/Cancellation Form
  • Group Plan Roster Correction Form
  • Membership Guidelines
  • Life Brochure
  • Standard Portability Coverage
  • Standard Conversion Materials Request Form
  • Sample Life Coverage Letter to Employees
  • Group Disability Claim Form
  • 2025 Life Claim Form
  • ​2025 AD&D Claim Form
Copyright @ 2025 Vermont Vehicle and Automobile Dealers Association. 
​All Rights Reserved.


PO Box 747, Montpelier, VT 05601
Phone: (802) 461-2655  |  Fax (802) 461-2659
Website Design by Amanda Cashin Marketing

​The Vermont Vehicle and Automotive Distributors Association (VADA) is a trade association representing the interests of the automotive industry including new car and truck dealers, along with motorcycle, recreational vehicle, farm equipment, used-car, power equipment, and construction equipment dealers, as well as motor vehicle service, autobody repair, and motor vehicle parts sales facilities.
  • Home
  • About Us
    • Board of Directors
    • VADA Staff
  • Advocacy
  • Insurance Trust
    • Product Offerings
    • Forms & Guidelines
    • Provider Information
  • Consumer Resources
    • Automotive Technology Programs
    • Car Buying Guide
    • How to Get Off Mailing Lists
  • Contact Us