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
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