Mail, e-mail, or fax completed forms to MVP New Hamphsire Sales:

Mail: MVP Health Care Attn: Sales - 33 South Commercial Street Suite 303, Manchester, NH 03101
Email: NHSales@MVPHealthcare.com
Fax: 603-647-9607

Please write clearly on all faxed forms; this will ensure correct loading of information.

For your convenience, you may download the following forms (in PDF format). If you prefer, you may also have the forms mailed to you. Please request them from your MVP representative. Click here for contact information.

Broker Paperwork

• New Business Checklist
• Questionnaire (general information about your agency)
• Check Remittal (tells MVP how you want to be paid)
• W-9 (please fill out and include with documents)

Sold Group/Member Paperwork

• Group Setup Agreement (must be signed by group and broker)
• MVP Enrollment/Change Form (new employee, reinstating an employee, adding a dependent, removing a dependent)
• Employment Verification Form
• Waiver (for employees covered elsewhere or waiving coverage)

HBAs must complete and sign, to the best of their ability, Section “9” of each application. No binder check is needed with enrollment paperwork. The amount will appear on the group's first bill.

Always include the group ID number and, if possible, the member's ID number when corresponding with MVP on any group or member issues.

MVP will only release group and member information to the HBA of the group, or to the Broker of Record of the group. If there is a change or addition to any of these contacts, please notify your MVP representative as soon as possible.