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 the Trust Program Manager, Nathan Edmondson at 206-602-3558 or Nathan.Edmondson@advprofessionals.com.


 

2019 Enrollment Forms
     Plan Year: Jan. 1, 2019 - Dec. 31, 2019

 

2018 Enrollment Forms
     Plan Year: Jan. 1, 2018 - Dec. 31, 2018


2019 ALLtech - Enrollment Forms  
  ALLtech Health Trust Enrollment Forms Regence
Asuris
  ALLtech Approved New Group Enrollment Census Download


Additional forms  
  New / Renewing Group Late Submission Form Download
  Authorization for Electronic Funds Transfer (EFT) Form Download
  COBRA Carryover Form Download
  Voluntary Waiver of Associated Industries (AI) COBRA Services Download

2018 ALLtech - Enrollment Forms  
  ALLtech Health Trust Enrollment Forms Regence
Asuris
  ALLtech Approved New Group Enrollment Census Download


Additional forms  
  New / Renewing Group Late Submission Form Download
  Authorization for Electronic Funds Transfer (EFT) Form Download
  COBRA Carryover Form Download
  Voluntary Waiver of Associated Industries (AI) COBRA Services Download


Insurance Carrier Forms


Medical




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Click here >

Dental




Click Here >

Life




Click Here >

Vision




Reimbursement Form




 

 

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