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.


FORMS LIBRARY

This section will allow you to access forms including Enrollment Forms, Claim Forms, Administrative Forms, and other forms.
Please choose a year or industry below to find information for various Trust Forms.

If you have any questions, please contact an AI Sales Representative:
Nathan Edmondson at 206.602.3558 or Nathan.Edmondson@advprofessionals.com

Paul Baker at 206.899.1895 or Paul.Baker@advprofessionals.com
Amanda Weidman at 206.962.3583 or Amanda.Weidman@advprofessionals.com


 

Enrollment Forms & Additional Forms

 


2023 Trust Industries - Enrollment Forms  
Industry Enrollment Forms
  Washington Commercial Construction Health Trust RegenceAsuris
  Washington Business Services Health Trust RegenceAsuris
  Washington Manufacturing Health Trust RegenceAsuris
  Washington Health Industry Health Trust RegenceAsuris
  Washington Retail Health Trust RegenceAsuris
  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
 
   
  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 RegenceAsuris
  Washington Business Services Health Trust RegenceAsuris
  Washington Manufacturing Health Trust RegenceAsuris
  Washington Health Industry Health Trust RegenceAsuris
  Washington Retail Health Trust RegenceAsuris
  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 RegenceAsuris Download
  Washington Business Services Health Trust RegenceAsuris Download
  Washington Manufacturing Health Trust RegenceAsuris Download
  Washington Health Industry Health Trust RegenceAsuris Download
  Washington Retail Health Trust RegenceAsuris 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




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Life




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Vision




Reimbursement Form




 

 

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