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.


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.


 

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
  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

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
  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


Insurance Carrier Forms


Medical




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Dental




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Life




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Vision




Reimbursement Form




 

 

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