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 the Trust Program Manager, Nathan Edmondson at 206-602-3558 or Nathan.Edmondson@advprofessionals.com. |
Enrollment Forms & Other Forms
| 2022 Kavi - Enrollment Forms | |
| Kavi Marketplace: Enrollment Form | Regence / Asuris |
| Kavi Marketplace: Census Enrollment Template | Download |
| [AP-Standardized] Life Beneficiary Enrollment Census Form | 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 |
| HealthEquity Integration Form | Download |
| LifeMap: Voluntary Life Form | Download |
| LifeMap: Beneficiary Designation Form | Download |
| Life/AD&D and EAP Form | Download |
| Late Submission Form | Download |
| Mail Order RX Forms | Preprinted Order Web Order |
| 2021 Kavi - Enrollment Forms | |
| Kavi Marketplace Enrollment Form | Regence / Asuris |
| Kavi Marketplace Census Enrollment Template | Download |
| [AP-Standardized] Life Beneficiary Enrollment Census Form | Download |
| Sound Benefit Administrators COBRA Application | Download |
| Other forms | |
| Affidavit of Qualifying Domestic Partnership | Regence / Asuris |
| Electronic Funds Transfer Authorization Agreement | Download |
| Health Equity Integration Form | Download |
| Life/AD&D and EAP Form | Download |
| Late Submission Form | Download |
| Mail Order RX Forms | Preprinted Order Web Order |
| 2020 Kavi - Enrollment Forms | |
| Kavi Marketplace Enrollment Form | Regence / Asuris |
| Kavi Marketplace Census Enrollment Form | Download |
| [AP-Standardized] Life Beneficiary Enrollment Census Form | Download |
| Sound Benefit Administrators COBRA Application | Download |
| Other forms | |
| Affidavit of Qualifying Domestic Partnership | Regence / Asuris |
| Electronic Funds Transfer Authorization Agreement | Download |
| Health Equity Integration Form | Download |
| Late Submission Form | Download |
| 2019 Kavi - Enrollment Forms | |
| Kavi Marketplace Enrollment Form | Regence / Asuris |
| Kavi Marketplace Census Enrollment Form | Download |
| Sound Benefit Administrators COBRA Application | Download |
| Other forms | |
| Electronic Funds Transfer Authorization Agreement | Download |
| Health Equity Integration | Download |
| Late Submission Form | Download |
Insurance Carrier Forms
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Medical |
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Dental |
Life |
Vision |
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