Health Alliance for Technology (ALLtech) is a true group benefit trust serving the technology community. The Trust has arranged group insurance contracts with Delta Dental of Washington, VSP Vision Care Inc., The Standard Insurance Company and Wellspring EAP to provide medical, dental, vision, life, accidental death and dismemberment (AD&D), voluntary life, employee assistance program (EAP) and disability coverage.
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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 ALLtech Sales Representative: |
Enrollment Forms & Additional Forms
| 2023 ALLtech - Enrollment Forms | |
| ALLtech: Enrollment Forms | Regence Asuris |
| ALLtech: Approved New Group Census Enrollment Template | Download |
| GeekWire Membership Link (Seed Pass) | Access |
| Additional forms | |
| Affidavit of Qualifying Domestic Partnership | Regence Asuris |
| New / Renewing Group Late Submission Form | Download |
| Electronic Funds Transfer (EFT) | EFT Guide EFT Authorization Form |
| Life/AD&D and EAP Form | Download |
| COBRA Carryover Form | Download |
| Voluntary Waiver of Associated Industries (AI) COBRA Services | Download |
| Beneficiary Form | Download |
| Affidavit of Qualifying Incapacitated Dependent Eligibility for Individual Coverage |
Download |
| 2022 ALLtech - Enrollment Forms | |
| ALLtech: Enrollment Forms | Regence Asuris |
| ALLtech: Approved New Group Census Enrollment Template | Download |
| GeekWire Membership Link (Seed Pass) | Access |
| Additional forms | |
| Affidavit of Qualifying Domestic Partnership | Regence Asuris |
| New / Renewing Group Late Submission Form | Download |
| Electronic Funds Transfer (EFT) | EFT Guide EFT Authorization Form |
| Life/AD&D and EAP Form | Download |
| COBRA Carryover Form | Download |
| Voluntary Waiver of Associated Industries (AI) COBRA Services | Download |
| Beneficiary Form | Download |
| Affidavit of Qualifying Incapacitated Dependent Eligibility for Individual Coverage |
Download |
| 2021 ALLtech - Enrollment Forms | |
| ALLtech Health Trust Enrollment Forms | Regence Asuris |
| ALLtech Approved New Group Enrollment Census | Download |
| [AP-Standardized] Life Beneficiary Enrollment Census | Download |
| GeekWire Membership Link (Seed Pass) | Access |
| Additional forms | |
| Affidavit of Qualifying Domestic Partnership | Regence Asuris |
| New / Renewing Group Late Submission Form | Download |
| Authorization for Electronic Funds Transfer (EFT) Form | Download |
| Life/AD&D and EAP Form | Download |
| HealthEquity Form | Download |
| COBRA Carryover Form | Download |
| Voluntary Waiver of Associated Industries (AI) COBRA Services | Download |
Insurance Carrier Forms
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Medical |
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Dental |
Life |
Vision |
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