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Forms

Individual Insurance

All Individual insurance plans require completion of the Washington State Health Questionnaire. You can download and print out a copy of it here.

Regence Individual

  1. Regence Individual Application
  2. Regence Individual Autopay Form

Group Health Individual

  1. Group Health Individual Application
  2. Group Health Individual Autopay Form

Lifewise Individual

  1. Lifewise Individual Application
  2. Lifewise Individual Autopay Form

 Group Insurance

Regence

  1. Group Master Application
  2. Employee Application
  3. Verification of Employment
  4. Small Group Tax Documentation Requirements

     

Group Health Care

  1. Group Master Application
  2. Employee Enrollment Form
  3. Waiver of Coverage Form

 

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