Regence BlueShield   LifeWise of WA   Group Health   Comprehensive Plans     Balance 1250     Balance 1750     Welcome 750   Catastrophic Plans     Balance 2500     Balance 5000     Welcome 1820     Welcome 3500   HSA Plan     HealthPays HSA   Plan Rates   Apply Now!   Provider Directories   Exclusions &    Limitations   HSA Plans   Individual Dental   Group Medical   Group Dental   Grp Life & Disability   About the Plan   Premiums   Application   US Citizens   Foreign Nationals   Long Term		(Available to Washington State Residents Only) Group Health Individual Medical Application Process and Forms There are now 2 ways to enroll in a Group Health Plan Online Enrollment To Enroll On-Line – Click Here or Print and Mail Enrollment Forms Fill out the Application (one per family) Click here to download the Group Health Individual/Family Enrollment Application. Print the application and fill it out completely. Fill out the Questionnaire (one for each person to be covered) Click here to download the Standard Health Questionnaire for Washington State. Print and complete the questionnaire for each person to be covered on the plan. Please refer to Completing the Health Questionnaire to determine if this applies. Provide Proof of Washington State Residency To be eligible to purchase this plan you must be a Washington state resident. A photocopy of one of the following must accompany your application to prove residency: Valid Washington State Driver's License or Identification Card Washington State Voter Registration Card Current Utility Bill in your name, including address Provide Certificate of Creditable Coverage (if available) Please refer to Credit for Prior Coverage & HIPPA Eligibility for more information. Please note, if you do not have your Certificate of Creditable Coverage at the time of application, please submit your application anyway. Credit for pre-existing condition waiting periods will be credited upon receipt of your Certificate of Creditable Coverage by Group Health. If applying for an HSA plan: Fill out the HSA Application & Forms (one per family) Click here to enroll on-line (fastest way to set up an account) or Click here to print the HSA Application Packet and mail it in. Send Payment You must send a check or money order with your application for your first month's premium payment. If you would like to pay via credit card, click here to download the form. If you would like to set up auto-pay via Electronic Funds Transfer, please click here to complete the Group Health Preauthorized Bill Payment form. Mail all Enrollment Materials to: Group Health Attn: Marketing, Individual & Family Plan 320 Westlake Ave. N., Suite 100 Seattle, WA 98109-5233 Your completed enrollment materials and payment must be received in the Group Health Seattle office by the 20th of the month for coverage to begin the first day of the following month. If your completed enrollment materials are received after the 20th, coverage will begin on the first day of the second month. For Example: If you wanted your medical insurance coverage to begin on June 1, you would need to send all of the required, completed enrollment material and first month's premium payment to Group Health postmarked on or before May 20. E-mail us for more information and a free quote or CALL TOLL FREE 1-800-875-4490 (in the U.S.) or 1-253-854-0199 (outside the U.S.) Fax: 1-253-896-9411 Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424 Serving all of Washington at 800-875-4490, Seattle at 206-682-1628, Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291. Copyright© 1998-2010, Maddock & Associates  |  Privacy Statement Problems viewing this page? Contact the webmaster.