1. If remaining on existing plan print Practice Enrollment/Change Form, circle "RENEW AS IS" and fax to MVP at 1-802-264-6507.
2. If the entire practice opts to change from your existing plan to a new plan. Print the the Practice Enrollment/Change Form, circle the plan of your choice and fax to MVP at 1-802-264-6507.
3. If your practice offers two plan designs and would like to make a change. Print Practice Enrollment/Change Form and circle the plans for the practice. Be sure to include an Employee Enrollment Form for each subscriber. Each subscriber must write plan identification # at the top of the form. Fax to MVP at 1-802-264-6507.
4. If your practice is not currently enrolled in one of the VSDS endorsed plans and your practice would like to join. Please complete the Practice Enrollment/Change Form, indicating the 1 or 2 plans you would like to offer. Have your participating employees complete the Employee Enrollment Form and have them hand write the plan identification # at the top of their form. Please fax to Affiliated Associates at 802-419-3091 or MVP at 1-802-264-6507. Be sure to include a copy of your Schedule C tax form required by MVP as proof of business.
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