Regence BlueShield   LifeWise of WA   Group Health   HSA Plans   Individual Dental     Smart Smile     Regence Dental       Incentive Plan       Dollar-Based Plan       Exclusions       Plan Rates       Apply Now!   Group Medical   Group Dental   Grp Life & Disability   About the Plan   Premiums   Application   US Citizens   Foreign Nationals   Long Term		How to Apply There are now 2 ways to enroll in the Regence Individual Dental Plan: 1. Online Enrollment    To Enroll On-Line, enter your zip code and then click on the "Enroll" button.    Zip Code:    or 2. Print and Mail Enrollment Forms Choose the dental insurance plan that best meets your needs. Click here to download the application. Print and complete the application in full. Missing information may cause your effective date to be delayed. If you have more than four children, please attach a separate list. If you are enrolling a non-state certified domestic partner, please complete the attached affidavit. Calculate the premium. Indicate if you are enrolling for the Optional Vision coverage. Be sure to select a monthly or quarterly payment schedule. Include the applicable payment for the first month or quarter of coverage, according to the payment schedule you have selected. You may enroll for Child Only coverage. If you are enrolling children only, a separate application must be completed and submitted for each child. If you have any questions, please call 503-721-7161 or toll-free 1-800-794-5390. Send the application and your check or money order made payable to Regence Life and Health Insurance Company to: Regence Life and Health Insurance Company PO Box 1271, MS E-3A Portland, OR 97207-1271 Refunds If you are not satisfied with this Policy, you may return the policy within 10 days of delivery for a full refund of premium. An additional ten percent penalty will be added to any premium refund due that is not paid within 30 days of return of the Policy to the insurer or agent. Please read your policy carefully and keep it available for future reference. 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© 1998-2009, Maddock & Associates  |  Privacy Statement Problems viewing this page? Contact the webmaster.