Kavi Marketplace has designed a website to provide you with the latest announcements and the ability to view, print and download information about the employee benefit plans available to qualified groups.
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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 Kavi Sales: |
Enrollment Forms & Other Forms
| 2024 Kavi - Enrollment Forms | |
| Kavi Marketplace: Enrollment Form | Regence / Asuris |
| Kavi Marketplace: Census Enrollment Template | Download |
| Annual Certification Form (Regence / Asuris) | Regence / Asuris |
| COBRA: Sound Benefit Administrators COBRA Application | Download |
| COBRA: How to Count Employees for COBRA Eligibility | Download |
| Regence & Asuris - Group Change Form | Download |
| Regence & Asuris - Renewal & Maintenance Form | Download |
| Other forms | |
| Affidavit of Qualifying Domestic Partnership | Regence / Asuris |
| Affidavit of Qualifying Incapacitated Dependent Eligibility for Individual Coverage | Download |
| Electronic Funds Transfer Authorization Agreement | Download |
| LifeMap: Voluntary Life Form | Download |
| LifeMap: Beneficiary Designation Form | Download |
| Life/AD&D and EAP Form | Download |
| Mail Order RX Forms | Preprinted Order Web Order |
| 2023 Kavi - Enrollment Forms | |
| Kavi Marketplace: Enrollment Form | Regence / Asuris |
| Kavi Marketplace: Census Enrollment Template | Download |
| Annual Certification Form (Regence / Asuris) | Regence / Asuris |
| COBRA: Sound Benefit Administrators COBRA Application | Download |
| COBRA: How to Count Employees for COBRA Eligibility | Download |
| Regence & Asuris - Group Change Form | Download |
| Regence & Asuris - Renewal & Maintenance Form | Download |
| Other forms | |
| Affidavit of Qualifying Domestic Partnership | Regence / Asuris |
| Affidavit of Qualifying Incapacitated Dependent Eligibility for Individual Coverage | Download |
| Electronic Funds Transfer Authorization Agreement | Download |
| LifeMap: Voluntary Life Form | Download |
| LifeMap: Beneficiary Designation Form | Download |
| Life/AD&D and EAP Form | Download |
| Mail Order RX Forms | Preprinted Order Web Order |
| 2022 Kavi - Enrollment Forms | |
| Kavi Marketplace: Enrollment Form | Regence / Asuris |
| Kavi Marketplace: Census Enrollment Template | Download |
| Annual Certification Form (Regence / Asuris) | Regence / Asuris |
| COBRA: Sound Benefit Administrators COBRA Application | Download |
| COBRA: How to Count Employees for COBRA Eligibility | Download |
| Regence & Asuris - Group Change Form | Download |
| Regence & Asuris - Renewal & Maintenance Form | Download |
| Other forms | |
| Affidavit of Qualifying Domestic Partnership | Regence / Asuris |
| Affidavit of Qualifying Incapacitated Dependent Eligibility for Individual Coverage |
Download |
| Electronic Funds Transfer Authorization Agreement | Download |
| LifeMap: Voluntary Life Form | Download |
| LifeMap: Beneficiary Designation Form | Download |
| Life/AD&D and EAP Form | Download |
| Mail Order RX Forms | Preprinted Order Web Order |
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Medical |
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Dental |
Life |
Vision |
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