Committed to exemplary service, the Industry Health Trusts offered by Associated Industries provide Washington state employers comprehensive, reliable employee benefits. In the ever-changing business environment, our team and services provide stability to a company’s health benefits and connects you to a wide spectrum of tools and resources you can utilize to keep organizations adaptable and growing.
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FORMS LIBRARY |
This section will allow you to access forms including Enrollment Forms, Claim Forms, Administrative Forms, and other forms. If you have any questions, please contact an AI Sales Representative: |
Enrollment Forms & Additional Forms
2023 Trust Industries - Enrollment Forms | |
Industry | Enrollment Forms |
Washington Commercial Construction Health Trust | Regence / Asuris |
Washington Business Services Health Trust | Regence / Asuris |
Washington Manufacturing Health Trust | Regence / Asuris |
Washington Health Industry Health Trust | Regence / Asuris |
Washington Retail Health Trust | Regence / Asuris |
AIMS-Approved New Group Enrollment Census | Download |
2023 Employee Enrollment & Change Form: Non-Med | Download |
Additional Forms | |
Associated Industries Membership Applications | AI Basic Application AI Executive Application |
Affidavit of Qualifying Domestic Partnership | Asuris Regence |
Affidavit of Qualifying Incapacitated Dependent Eligibility for Individual Coverage |
Download |
New / Renewing Group Late Submission Form | Download |
ACH - Authorization for Electronic Funds Transfer (EFT) Form (Download) Electronic Funds Transfer (EFT) Guide - Associated Employers Trust (AET) - Business - Construction - Healthcare - Manufacturing - Retail |
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Beneficiary Form | Download |
Life/AD&D and EAP Form | Download |
Life Claim Packet | With Group No. Without Group no. |
COBRA Carryover Form | Download |
COBRA Voluntary Waiver Form | Download |
Owner Verification Form | Download |
2022 Trust Industries - Enrollment Forms | |
Industry | Enrollment Forms |
Washington Commercial Construction Health Trust | Regence / Asuris |
Washington Business Services Health Trust | Regence / Asuris |
Washington Manufacturing Health Trust | Regence / Asuris |
Washington Health Industry Health Trust | Regence / Asuris |
Washington Retail Health Trust | Regence / Asuris |
AIMS-Approved New Group Enrollment Census | Download |
2022 Employee Enrollment & Change Form: Non-Med | Download |
Additional Forms | |
Associated Industries 2022 Membership Applications | AI Basic Application AI Executive Application |
Affidavit of Qualifying Domestic Partnership | Asuris Regence |
Affidavit of Qualifying Incapacitated Dependent Eligibility for Individual Coverage |
Download |
New / Renewing Group Late Submission Form | Download |
ACH - Authorization for Electronic Funds Transfer (EFT) Form (Download) Electronic Funds Transfer (EFT) Guide - Associated Employers Trust (AET) - Business - Construction - Healthcare - Manufacturing - Retail |
|
Beneficiary Form | Download |
Life/AD&D and EAP Form | Download |
Life Claim Packet | With Group No. Without Group no. |
COBRA Carryover Form | Download |
COBRA Voluntary Waiver Form | Download |
Owner Verification Form | Download |
2021 Trust Industries - Enrollment Forms | ||
Industry | Enrollment Forms | Trust Fee Disclosure Statement (for 2021 GMA) |
Washington Commercial Construction Health Trust | Regence / Asuris | Download |
Washington Business Services Health Trust | Regence / Asuris | Download |
Washington Manufacturing Health Trust | Regence / Asuris | Download |
Washington Health Industry Health Trust | Regence / Asuris | Download |
Washington Retail Health Trust | Regence / Asuris | Download |
AIMS-Approved New Group Enrollment Census | Download | - |
[AP-Standardized] Life Beneficiary Enrollment Census | Download | - |
2021 Employee Enrollment & Change Form: Non-Med | Download | - |
Additional Forms | |
Affidavit of Qualifying Domestic Partnership | Asuris Regence |
New / Renewing Group Late Submission Form | Download |
ACH - Authorization for Electronic Funds Transfer (EFT) Form | Download |
Electronic Funds Transfer (EFT) Guide - Business | Download |
Electronic Funds Transfer (EFT) Guide - Construction | Download |
Electronic Funds Transfer (EFT) Guide - Healthcare | Download |
Electronic Funds Transfer (EFT) Guide - Manufacturing | Download |
Electronic Funds Transfer (EFT) Guide - Retail | Download |
Life/AD&D and EAP Form | Download |
HealthEquity Form | Download |
COBRA Carryover Form | Download |
COBRA Voluntary Waiver Form | Download |
Owner Verification Form | Download |
Insurance Carrier Forms
Medical |
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Dental |
Life |
Vision |
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