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 kgauthier@vermontada.org.
​
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
  • Group Disability Claim Form
  • Death Claim Form
Copyright @ 2022 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
    • Membership
  • Member Resources
    • Membership Directory
    • Compliance & Regulatory
    • Vermont Compliance
    • Federal Compliance
    • National Automobile Dealers Association (NADA)
  • Advocacy
    • Legislative & Policy Issues
  • Insurance Trust
    • Product Offerings
    • Forms & Guidelines
    • Provider Information
  • Consumer Resources
    • Industry Information
    • Automotive Technology Programs
    • Car Buying Guide
    • How to Get Off Mailing Lists
  • Contact Us