Savoy-RPS Update | BOR Templates for New Business Only

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Published: 09.03.2025

Carrier Contracting
Savoy will be working with each carrier partner to update contracting under the RPS tax identification number, and many carrier systems will begin to reflect the RPS name.

5500 Filings
For group business with 100 or more enrolled employees that require Form 5500 filings, you will need to use the RPS tax identification number. 

New Templates (for new business only)
For each carrier, Savoy will provide notification if anything additional is required by the carrier for new or future BOR business.

Carrier	GA Code	BOR
Aetna	36-3110841	Aetna Medical and Ancillary BOR Template current 2025 RPS
AmeriHealth	06853G	AmeriHealth BOR Template and Employer Authorization Form for Portal Access SG-Midsize-Specialty - WORD Version 2025 RPS
Anthem	36-6110841	Anthem BOR Template
Cigna Healthcare	670408	Cigna BOR Medical and Specialty Benefits - SG and 51+ Sample Temple 2025 RPS
Delta Dental	36-3110841	Delta Dental PA BOR template 2025 RPS Delta Dental BOR Sample Template NJ & CT 2025 RPS
Emblem	G00000000072	Emblem BOR Template 2025 RPS
Florida Blue	parent code W123 (with satellite codes W124, W125, W126, W127, W128)	Florida Blue - Agent of Record Change Request Form 2025
Guardian	000UD404	Guardian BOR Sample Template
Hartford	0655508000	Hartford BOR Template
HealthPass	280	HealthPass BOR Template 2025 RPS
Highmark	CPA 0002635326 DE 0002635325 NEPA 0002635131 SEPA 0002635327 WNY 0002635129 WPA 0002635133	Highmark Delaware BOR Template Highmark Western NY_BOR_Template   Highmark PA (all regions) BOR Template Highmark PA (all regions) BOR Template 100+
Horizon BCBSNJ	0032	Small Group: Horizon BCBSNJ BOR SG Medical and Ancillary Template   51+ Business: Horizon BCBSNJ BOR 51+ Medical and Ancillary Template
Independence Blue Cross	06853	IBC Broker of Record Template and Employer Authorization Form for Portal Access 2025 RPS
Standard	634200	Standard BOR Sample Template 2025 RPS
UCCI	056441	UCCI BOR Template
Unum	476104  30071	UNUM BOR Template 2025 RPS
USAble		USAble BOR Sample Template 2025 RPS
United Healthcare/ Oxford	NJ 0000497  PA 0000743   NY 0000981	United Healthcare - Medical and or ancillary BOR Sample Template NY 2025 RPS United Healthcare - Medical and or ancillary BOR Sample Template NJ 2025 RPS United Healthcare - Medical and or ancillary BOR Sample Template PA 2025 RPS Oxford BOR Template 2025 RPS NY Oxford BOR Template 2025 RPS NJ Oxford BOR Template 2025 RPS PA

Stay tuned for more information.
On behalf of the Savoy-RPS team, we thank you for your partnership. We encourage you to reach out to your dedicated Savoy team to discuss new opportunities and additional resources to grow your business.

Questions?
For any questions about BORs, please contact our BOR team at bor@savoyassociates.com.

Savoy BOR Team
bor@savoyassociates.com
Round Table Studios, Suite 1000
200 Connell Drive
Berkeley Heights, NJ 07922
P: 973.377.2220
F: 973.377.6887