To help you work with MetLife and deliver on your commitments to your clients, this page provides convenient access to frequently requested broker and customer forms. Just click on the links provided to view and download the appropriate forms, available in pdf format. Submission instructions are also provided for each form.
Frequently requested broker and customer forms:
Commission Agreements
When you have a license from a state to sell insurance and are appointed by MetLife, you need to complete and return a signed Commission Agreement in order to be paid commission. For your convenience, you may sign up for electronic funds transfer (EFT) using the Direct Deposit Authorization form below.
Contact your MetLife representative for additional information about commissions and for assistance in selecting and completing the appropriate commission agreement.
Forms
- Standard Commission Agreement
- Non-Standard Commission Agreement – for all markets
- Single Case Commission Agreement
- PetFirst HealthCare Commission Agreement
Submission Instructions
Please send completed form(s) to: |
Please email completed pet commission form to: |
Direct Deposit Authorization Form
Request for Assignment of Commissions Form
Broker Change Requests
When an existing MetLife customer wishes to change their broker of record designation, the request must be submitted in writing by the Customer. The Broker of Record Change Request Template may be used as a guide for the customer. It is acceptable for the original request from the customer to be forwarded by a broker.
Submission Instructions
We have improved our Broker Change process to better serve our Broker Community! This improvement will reduce the processing time significantly to ensure commissions are paid quicker once premium is received by implementing a self-service tool.
In order to expedite processing of a broker change request, please click on the link below and complete the request page. You will need to attach the Customer Letter and the Producer Appointment Inquiry (PAI) form for Group Life/Health coverages if the payee is not appointed in Customer Situs State. If you are already appointed with MetLife and know your MetLife Broker/Brokerage codes, please provide. They are not required, but it will help speed up the verification process. Please check all products that are affected as the appropriate departments will receive an email alert with your request. Even if we are paying an agency, we will still need the writing producer information.
Broker of Record Change Request
Forms
For Group Auto/Home: the PAI is not required. However, the agency/brokerage firm does needs to hold a P&C license in 10 specific states (FL, GA, KY, MA, MS, NM, SC, SD, VA & WV) in order to receive commissions for policies issued in those states. Of those 10 states, FL, GA, MS, NM, SC, SD & WV require the principal officer of the agency to hold a P&C license in order to receive commissions for policies issued in those states.
For MetLife Legal Plans: the PAI is not required. However, the agency/brokerage firm does needs to hold a P&C license in the following states: FL, KS, MA, MS, MT, NY, OR, RI, TN, UT, VA, WI.
For Group Pet Insurance: the PAI is not required. However, the agency/brokerage firm & the principal officer MUST hold a P&C license AND be appointed by the third party carrier (IAIC) in their resident state to receive any commissions for policies issued. The agency/brokerage firm & the principal officer MUST also hold a P&C license AND be appointed by the carrier (IAIC) in order to receive any commissions for policies issued in the following states: KY, MA, MT, NY, PA & VA. Finally, a P&C license is also required to receive any commissions for policies issued in WV. The third party carrier appointment form can be found here. In addition, a separate commission agreement is required because the coverage is currently underwritten by the third party.
Contact Instructions
Pet_Admin_Broker_Commissions@metlife.com
Pet_appointments@metlife.com and Pet_appointments@IHCgroup.com
MetLink User Authorization form
Your clients can elect to give you access to their administrative information on MetLife's online benefits management system - MetLink - by completing and submitting the MetLink User Authorization Form. MetLink puts simplified administrative tools, including enrollment services, claims status and billing access, at your fingertips. Click here for a demo of MetLife's eService options or contact your MetLife representative for more information.
Forms
Submission Instructions
Please send completed form(s) to:
MetLink User Authorization
Attention: Administration
PO Box 14593
Lexington KY 40512-4593
Fax #: 1- 888-505-7446
HIPAA Privacy & Security
To comply with HIPAA requirements on how MetLife may disclose "protected health information" ("PHI") to brokers and consultants concerning customers and/or the insureds, all current brokers who sell Dental or Long Term Care business who have not already signed an agreement containing the privacy and security language, must execute the HIPAA Privacy and Security Business Associate Agreement with MetLife.
By signing, brokers agree to take certain steps and procedures to protect any PHI, including PHI transmitted electronically, that MetLife may share with them. For your convenience, the form, along with a fax cover sheet for submission to MetLife, is provided below.
Forms
Submission Instructions
Please send completed form(s) to:
HIPAA - MetLife Producer Services
FAX: 1-800-556-9430
Dental Claim Form
Forms
Submission Instructions
Please send completed form(s) to:
MetLife Dental Claims
PO Box 981282
El Paso, TX 79998-1282