Individual Health
Enrollment Forms
| To apply for any of the plans
shown, see the instructions below.
Lifewise of
Washington
Regence Blue Shield
KPS Health Plans of Washington
Assurant Insurance
If you have any questions or need help
completing the application process
please call our office at 1-866-527-1910
(PST).
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Lifewise of Washington |
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Apply
Online You may either apply directly online now
or print out and complete the enrollment forms ( see below). |
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Lifewise
Individual Application
- Download Now
| To print an application
simply click on the link above and then print, or you
may choose to apply online. If you choose to
mail in your application you will need to complete a
Standard Health
Questionnaire for each person applying for coverage
unless you meet one of the exclusionary
requirements as outlined on the application.
If you are applying online the Questionnaire to complete
will be provided to you through the online process. |
Send all Enrollment Materials to:
Lifewise of Washington
PO Box 91120
MS 295
Seattle, WA 98111-9220
You can choose from two effective dates – the 1st or 15th of
the month. For a 1st of the month effective date, applications
must be postmarked by the 20th of the previous month. For a 15th
of the month effective date, applications must be postmarked by
the 5th of the same month.
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Please do not send a rate payment with your application. You will receive a
statement from Regence BlueShield upon acceptance of your application.
The mailing address to send your completed application directly the insurance
company is shown on the application after you print it out.
Please note: All COMPLETED enrollment materials should
postmarked prior to the 20th of the of the month for which coverage to
become effective for.
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KPS Health
Plans of Washington |
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KPS
Health Plan Application
- Download Now
To print
an application simply click on the link above and then
print.
You Will also need to complete a
Standard Health
Questionnaire for each person applying for coverage
unless you meet one of the exclusionary requirements
as outlined on the application.
KPS requires a check along with your
enrollment materials for the first months premium made
payable to KPS
Health Plans.
The mailing address to send your completed application
directly the insurance company is shown on the application
after you print it out.
The mailing address to send your completed
application directly the insurance company is shown on the
application after you print it out.
Please note: All COMPLETED
enrollment materials should postmarked prior to the 20th of the of the month for
which coverage to
become effective for.
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an
instant
health
insurance
quote
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Assurant
Health Insurance |
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Assurant Application
- Download Now
Standard Health
Questionnaire
To apply for coverage please print
out one application by clicking on the following line.
For each applicant applying a separate health questionnaire
must be completed, which may printed out from the following
link; Standard Health
Questionnaire.
If you are applying for a HSA with
Assurant this
supplement application should be completed and returned
along with the Application and Health Questionnaires'.
HSA Supplement Application
Assurant Health an application must be
completed along with a Standard Health Questionnaire for
each person applying must be completed and accompany the
application. The application should be mailed directly
to our General Agents mailing address of;
Westcoast Agencies Inc
PO Box 2168
Battle Ground, WA 98604
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