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.


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 ALLtech Sales Representative:

Paul Baker at 206.899.1895 or Paul.Baker@advprofessionals.com
Nathan Edmondson at 206.602.3558 or Nathan.Edmondson@advprofessionals.com
Amanda Weidman at 206.962.3583 or Amanda.Weidman@advprofessionals.com


 

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


Medical




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Dental




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Life




Click Here >

Vision




Reimbursement Form




 

 

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