Employee Enrollment/Change Forms

2011 -2012 Enrollment/Change Form -- Regence BlueShield (effective date  10/11 -- 09/12)

2011 -2012 Enrollment/Change Form -- Asuris Northwest Health(effective date 10/11 -- 09/12)

2010-2011  Enrollment/Change Form --Regence BlueShield (effective date 10/1/10 or later)

2010 -2011 Enrollment/Change Form -- Asuris Northwest Health (effective date 10/1/10 or later)

Insurance Carrier Claim and Other Forms

Regence BlueShield Domestic Partner Coverage Form

Asuris Northwest Health Domestic Partner Coverage Form

Group Health Options Domestic Partner Coverage Form

Regence BlueShield Employee Waiver Form

Asuris Northwest Health Employee Waiver Form

Group Health Options Deductible Credit  Form

Regence BlueShield Claim Form

Asuris Northwest Health Claim Form

Group Health Options Claim Form

21st Century Legal Employee Enrollment Form

Chartis Beneficiary Card

Chartis Personal Accident Enrollment Form

Life & LTD Insurance Carrier Forms

Regence Life and Health LTD Claim Form

Regence Life and Health Evidence of Insurability

Regence Life and Health Death Claim Form

Regence Life and Health Life Conversion Form

Regence Life and Health Waiver of Premium Claim Form