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Step
1: Complete an application |
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Apply online or by paper application by following the instructions
below.
Helpful Tips: Only
one application is required per family if your entire
family is applying for the same plan. But if you and your
spouse want different plans, for example, a different
carrier or a different deductible with the same carrier,
then complete a separate application for each of you and include
any children under either of your applications. If enrolling a child
or children only (without an adult), each of them must be covered
under their own plan using the rate for an adult under age 25.
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Online (easiest and quickest)
Click
here
to go to Asuris's online quoting and application web site. A step-by-step guide on what to expect
on the Regence web site is shown in numbers 1 to 3 below.
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- On
the opening page, read the "Appointed Agent Acknowledgement
Statement" and click on the "Continue" button.
- On
the next "Shop for Coverage" page, enter your zip code and the information for who you want to cover.
Then click on the "Next" button.
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On the next page you'll see all Asuris plans and rates.
Scroll down the page to the plan you want, and click on the
"Apply" button next to the monthly rate.
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Paper Application
To download a paper application, click here. This
is an Acrobat Reader document.
The application
includes fill-in blanks so you can complete the form on your PC before
printing it. Adobe Acrobat
Reader version 5.0 or newer is required to use the fill-in blanks (click
here to download the latest free version
of Acrobat Reader).
The application is 183KB in size, so depending on your connection
speed it
may take between a few seconds (broadband connection)
to a minute or so to appear on your screen. Or call us
and we'll send or email the application you need along with the
Standard Health Questionnaire described below.
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Step
2: Complete the Standard Health Questionnaire (SHQ) |
If you apply online, this step is not necessary because the online
process includes completing the SHQ.
To download the SHQ, click
here. This is an
Acrobat Reader document.
The SHQ does not include fill-in blanks, so you must print and
complete it by hand. The SHQ is 388KB in size, so it may take a few
seconds to a minute or so to appear on your screen.
A
separate questionnaire must be completed for each family member. If enrolling a child under age 18, you or
your spouse must complete the questionnaire on behalf of your
child and sign for the child. Eligible, dependent children
age 18 and older must complete and sign the questionnaire for themselves.
Children are eligible only if under
age 23.
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Step
3: Paying for your plan |
Do
not send a check or money order with your application. If
your application is accepted, you will be billed.
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Step 4:
Deadline to apply |
The deadline to apply is the 20th if you want coverage to begin on the
first day of the next month. For example, if you want coverage to
begin on June 1, the deadline is May 20.
If applying by paper application, the application must be postmarked
by the 20th.
Missing information and/or a delay in receiving the information by the
date shown above may cause a delay in the
effective date of your plan.
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Step 5:
Send completed information to... |
Asuris Northwest Health
PO Box 1107
1602 21st Ave. MS LC1NW
Lewiston, ID 83501 |
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THANK YOU!
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