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Enrollment Application Change FormGEISINGER HEALTH PLAN 100 N. Academy Ave. Danville, PA 17822GEISINGER QUALITY OPTIONS, INC. 100 N. Academy Ave. Danville, PA 17822Effective date of change: SUBSCRIBER

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What is broker of record request?

A broker of record request is a formal document that authorizes a specific insurance broker to act on behalf of a client in managing their insurance policies.

Who is required to file broker of record request?

Typically, the client or policyholder who wishes to change their insurance broker is required to file the broker of record request.

How to fill out broker of record request?

To fill out a broker of record request, you need to provide your personal information, details about your existing broker, the new broker's information, and sign the document to authorize the change.

What is the purpose of broker of record request?

The purpose of a broker of record request is to officially change the designated broker who will manage a client's insurance needs, ensuring the new broker has the authority to represent the client.

What information must be reported on broker of record request?

The information that must be reported includes the client's name and contact information, details of the current broker, information about the new broker, and any specific policies affected by the change.

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