Forms & Resources
Below you'll find forms and resources organized by line of business or service and plan year. 2020 documents will be posted as they become available. Some forms may only be available on our secure site. If you can't find the form you need or require further assistance, please contact us.
Wellness
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Pharmacy
View our pharmacy services.
Individual and Family
- Plan Information and Brochures
- Forms
- Plan Information and Brochures
Plan Value Brochure for businesses headquartered in Puget Sound (PDF)
Elect PPO service area map (PDF)
Elect PPO FAQ (PDF)
Small Group Rating Areas (PDF)
Health Plans for Small Business (PDF)
Plan Value Brochure for businesses headquartered in all other WA counties (PDF)
Getting Care Core Guide (PDF)
Getting Care Access PPO Guide (PDF)
Compare your plans options brochure (PDF)
Access PPO FAQ (PDF)
- Forms
- Plan Information and Brochures
Access PPO Upfront Benefits Summary (PDF)
Access PPO Basic Benefits Summary (PDF)
Access PPO Basic Upfront (PDF)
HMO HealthPays HSA Benefits Grid (PDF)
Standard Plan Rules (PDF)
Getting Care with Access PPO Puget Sound Plans (PDF)
Getting Care with Access PPO Spokane Plans (PDF)
Getting Care with Access PPO Plans (PDF)
Getting Care with Core/Kaiser Permanente Plans (PDF)
Service Area Map - Core (PDF)
Service Area Map - PPO (PDF)
- Forms
Employee Enrollment and Change Form (PDF)
Group Master Application (PDF)
Health Equity - HSA and HRA Banking Arrangement (website)
Census Template (XLS)
- Forms and Websites
Silver & Fit Flyer (PDF)
Star Rating Flyer (PDF)
KPIF and Medicare Sales Contact Sheet (PDF)
Enrollment Form (PDF)
Summary of Benefits Key (HMO) (PDF)
Summary of Benefits Basic (HMO) (PDF)
Summary of Benefits Centennial and Columbia (HMO) (PDF)
Summary of Benefits Harbor (HMO) (PDF)
Summary of Benefits Vital, Essential, Optimal (HMO) (PDF)
Scope of Appointment Form (PDF)
Service Area Map (PDF)
- Population Health Management
- Occupational Health Services
- Other Forms
Small Group
Large Group
Medicare Advantage
Other
Individual and Family
- Plan Information and Brochures
- Forms
- Websites
Individual and Family Plans Member Website (Kaiser Permanente's member website for individuals and families)
Tax Credit (Subsidy) Calculator (Website)
Washington Healthplanfinder (Online Exchange marketplace)
- Plan Information and Brochures
2019 Compare your plans options brochure (PDF)
Access PPO FAQ (PDF)
Access PPO Key Providers (PDF)
Compare Your Plan Options (PDF)
Getting Care with Access PPO Plans (PDF)
Getting Care with Core/Kaiser Permanente Plans (PDF)
Glossary of Health Coverage and Medical Terms (Brochure)
Rating Area Map (PDF)
- Forms
- Plan Information and Brochures
Access PPO Basic Benefits Grid (PDF)
Access PPO Basic Benefits Summary (PDF)
Access PPO HSA Benefits Summary (PDF)
Access PPO Upfront Benefits Summary (PDF)
Getting Care with Access PPO Plans (PDF)
Getting Care with Access PPO Puget Sound Plans (PDF)
Getting Care with Access PPO Spokane Plans (PDF)
Getting Care with Core/Kaiser Permanente Plans (PDF)
HMO Benefits Grid (PDF)
HMO HealthPays HSA Benefits Grid (PDF)
Service Area Map HMO (PDF)
Service Area Map PPO (PDF)
- Forms
- Forms and Websites
- Population Health Management
- Occupational Health Services
- Other Forms
Authorization to Disclose Health Plan Info (PDF)
Benefit and Prescription Claim Form (PDF)
HSA Preventive Medication Flyer (PDF)
Important Disclosure Document (PDF)
Mail Order Pharmacy Resource Card (PDF)
OptumRx Claim Reimbursemet Form (PDF)
OptumRx Pharmacies (PDF)