Form preview

Get the free Broker-of-Record Change Letter

Get Form
We are not affiliated with any brand or entity on this form
Illustration
Fill out
Complete the form online in a simple drag-and-drop editor.
Illustration
eSign
Add your legally binding signature or send the form for signing.
Illustration
Share
Share the form via a link, letting anyone fill it out from any device.
Illustration
Export
Download, print, email, or move the form to your cloud storage.

Why pdfFiller is the best tool for your documents and forms

GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

End-to-end document management

From editing and signing to collaboration and tracking, pdfFiller has everything you need to get your documents done quickly and efficiently.

Accessible from anywhere

pdfFiller is fully cloud-based. This means you can edit, sign, and share documents from anywhere using your computer, smartphone, or tablet.

Secure and compliant

pdfFiller lets you securely manage documents following global laws like ESIGN, CCPA, and GDPR. It's also HIPAA and SOC 2 compliant.
Form preview

What is BOR Change Letter

The Broker-of-Record Change Letter is a legal document used by organizations to appoint a new agent or agency as their exclusive representative with Coventry Health Care.

pdfFiller scores top ratings on review platforms

Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Show more Show less
Fill fillable BOR Change Letter form: Try Risk Free
Rate free BOR Change Letter form
4.3
satisfied
36 votes

Who needs BOR Change Letter?

Explore how professionals across industries use pdfFiller.
Picture
BOR Change Letter is needed by:
  • Businesses requiring an agent change for health insurance.
  • Decision makers in companies managing group health insurance.
  • Insurance brokers and agencies facilitating changes.
  • Human resources professionals handling employee benefits.
  • Legal advisors ensuring compliance with insurance regulations.

How to fill out the BOR Change Letter

  1. 1.
    Access pdfFiller and search for the Broker-of-Record Change Letter form in the document library.
  2. 2.
    Open the form by clicking on it from the search results.
  3. 3.
    Familiarize yourself with the fillable fields: Coventry Group #, Group Renewal Date, New Agent Name, New Agency Name and Address.
  4. 4.
    Gather all necessary information before filling out the form, such as group details and agent data.
  5. 5.
    Use pdfFiller's tools to click into each field and enter the required information logically and correctly.
  6. 6.
    Double-check entries for accuracy, ensuring the new agent details match your documentation.
  7. 7.
    Have the designated decision maker review and sign the letter electronically through pdfFiller’s signature feature.
  8. 8.
    Once complete, use the review option to ensure all fields are filled and correct.
  9. 9.
    Save the document securely within your pdfFiller account, or download it to your device.
  10. 10.
    For submission, send the completed letter to Coventry Health Care as instructed, ensuring it is on your group letterhead.
Regular content decoration

FAQs

If you can't find what you're looking for, please contact us anytime!
The letter must be signed by the designated decision maker for the group, whose authority is recognized to make such changes.
You will need to provide the Coventry Group #, Renewal Date, New Agent Name, Agency Name and Address, along with the decision maker's signature and title.
While specific deadlines can vary, it’s essential to submit the letter before the group's renewal date to ensure a smooth transition of representation.
After submission, Coventry Health Care will process the change and confirm the new agent’s appointment along with any commission assignment timelines.
No, notarization is not required for this document; however, it should be signed by an authorized decision maker on group letterhead.
You should submit the completed letter via the preferred method indicated by Coventry Health Care, typically by email or postal service.
Common mistakes include omitting required information, providing inaccurate agent details, or failing to secure the necessary signature from the decision maker.
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.