Regence BlueShield   LifeWise of WA Plans   Comprehensive Plans     WiseChoices 20     WiseChoices 30   Catastrophic Plans     WiseEssentials 25   HSA Plan     WiseSavings 20   Plan Rates   Apply Now!   Prescription Drugs   Provider Directory   Waiting Period     & Exclusions   FAQ's   HSA Plans     HSA Overview     Covered Expenses   LifeWise HSA Plan     Benefits/Coverage     Rates     Apply Now!     Provider Directory   Regence 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) LifeWise of Washington HSA Application Process and Forms To apply for any of the LifeWise of Washington HSA individual medical plans, please complete the following steps: Fill out the LifeWise Application (one per family) Click here to download the LifeWise of WA Individual/Family Enrollment Application. Print the application and fill it out completely. or Click Here to Enroll On-Line 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. 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 LifeWise of Washington. Do not Send a Payment Please do not send a rate payment with your application. You will receive a statement from LifeWise upon acceptance of your application. Send all Enrollment Materials to: LifeWise Health Plan of Washington P.O. Box 91120 Seattle, WA 98111-9220 Please note: LifeWise Health Plan of Washington requires all COMPLETED enrollment materials to be postmarked to their office on or before the 20th of the month. Incomplete enrollments may cause delays in the effective date of your coverage. Please refer to the checklist on the application to avoid delays. 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 to LifeWise 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© 1998-2008, Maddock & Associates  |  Privacy Statement Problems viewing this page? Contact the webmaster.