[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-279754-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-279754-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","uni-brk-broker-of-record-letter-template","UNI-BRK Broker of Record Letter Template","","Broker of Record designation letter template for Univera Healthcare. The document requests the Broker Administration team’s group letterhead submission and provides fields for group numbers, broker agency name and address, and an effective date. It states the company designates the named broker as its sole insurance representative for coverage provided by Univera Healthcare, acknowledges potential base and/or bonus compensation, and clarifies the designation remains effective until written notice to the contrary. Includes signature and officer details with optional authenticated e-signatures.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/letters/","Letters",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/uni-brk-broker-of-record-letter-template/279754/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/uni-brk-broker-of-record-letter-template/279754.png","ImageObject",442,249,{"name":42,"@type":43},"Clementine","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-16",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the purpose of this Broker of Record letter template?","Question",{"text":63,"@type":64},"It designates a specific broker agency as the company’s sole insurance representative for coverage provided by Univera Healthcare.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What details must be filled in before submission?",{"text":68,"@type":64},"The template requires group number(s), broker agency name and address, and an effective date, along with the company officer signature and printed officer information.",{"name":70,"@type":61,"acceptedAnswer":71},"How long does the designation remain effective?",{"text":72,"@type":64},"The designation remains in effect until the company notifies Univera Healthcare in writing to the contrary.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},279754,1790010215,{"code":4,"msg":82,"data":83},"success",[84,88,93,98,103,108,113,117,122],{"id":55,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":110,"show_sort_weight":111,"slug":112},17,"Forms",40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":115,"slug":116},18,30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":114,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":4},1374391974564,"https://ap-avatar.wpscdn.com/avatar/14000253aa45c000a9e?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779874745381141002","(TO BE SUBMITTED ON GROUP LETTERHEAD)  \nUnivera Healthcare  \nAttn: Broker Administration  \n165 Court Street  \nRochester, New York 14647  \nGroup Number(s):  \nBroker Agency Name:  \nBroker Agency Address: City, State, Zip Code  \nDear Broker Administration Team:  \nEffective (effective date), Our company hereby designates the above named Broker as our sole insurance representative with respect to All  \ncoverage provided to this organization by Univera Healthcare.  \nI understand that ifour company elects to purchase coverage from your company that  \nthe named Broker Agency may be entitled to base and/or bonus compensation for our business.  \nThis designation will remain in effect until we notify Univera Healthcare in writing to the contrary.  \nSincerely,  \nSignature of Company Officer  (e-signatures accepted if authenticated)  \nPlease print (Officer Name)  \nTitle of Company Officer","cbCaieWkWWqNK3Oh","https://ap.wps.com/l/cbCaieWkWWqNK3Oh","pdf",81447,"English","# Letterhead and Recipient Information\n## Company Designation Statement\n# Effective Date and Compensation Acknowledgment\n## Ongoing Validity and Written Notice\n# Signatures and Officer Details","[{\"question\":\"What is the purpose of this Broker of Record letter template?\",\"answer\":\"It designates a specific broker agency as the company’s sole insurance representative for coverage provided by Univera Healthcare.\"},{\"question\":\"What details must be filled in before submission?\",\"answer\":\"The template requires group number(s), broker agency name and address, and an effective date, along with the company officer signature and printed officer information.\"},{\"question\":\"How long does the designation remain effective?\",\"answer\":\"The designation remains in effect until the company notifies Univera Healthcare in writing to the contrary.\"}]","UNI-BRK Broker of Record Letter Template | PDF",1789526666]