FORMS LIBRARY This section will allow you to access forms for Regence BlueShield and Asuris Northwest.

 

2019 Plan Year
(January 1, 2019 to December 31, 2019)

 

Medical Forms (Regence BlueShield / Asuris Northwest Health)
 
  • Regence/Asuris Domestic Partner Affidavit (Regence) (Asuris)
  • Cambia Health Solutions HSA Health Equity Banking Agreement (Download)
  • Regence/Asuris Member Reimbursement Claim Form (Download)
  • Regence/Asuris Authorization to Disclose Protected Health Information (Download)
  • Group Size Certification Form (Regence) (Asuris)
  • Verification of Employment for Micro Groups (Download)
 

 

*No changes made to the forms from the 2018 Plan Year.

 

 

Copyright © 2019 Advanced Professionals. All rights reserved.