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
1284 US Route 302-Berlin, Suite 2
Barre, VT 05641

Faxed: (802) 461-2659 or emailed to Kim Gauthier at kgauthier@vermontada.org.
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Find a link below for forms and guidelines:

• Group Enrollment/Change Form Updated Nov 2020 
• Termination/Cancellation Form (Updated Feb 22)
• Group Plan Roster Correction Form
• Membership Guidelines
• UNUM Portability Coverage
• UNUM Portability Rates
• UNUM Conversion Privilege & Rates
• Sample Life Coverage Letter to Employees
• CMS Creditable Coverage Notice
• Group Disability Claim Form
• Death Claim Form