Forms and Resources

Individual and Family

Plan Information and Brochures

Individual and Family Cost Share Changes and Plan Mapping (PDF)

Getting Care with Core/Group Health Plans (PDF)

2017 Plan Rates (PDF)

Individual and Family Plan Application (PDF)

Adult/Family and Pediatric Dental Benefits with Rates (PDF)

Dental Application: For Members Enrolled Direct from Group Health (PDF)

Pediatric Dental Attestation (Direct from Group Health Only) (PDF)

Tobacco Affidavit (PDF)

The Group Health Approach to Health Care (PDF)

Websites

Individual and Family Plans Member Website
(Group Health's member website for individuals and families)

Tax Credit (Subsidy) Calculator

Washington Healthplanfinder
(Online exchange marketplace)

Premium Pay
(Website where members can pay their premium online)

Websites

Individual and Family Plans Member Website
(Group Health's member website for individuals and families)

Tax Credit (Subsidy) Calculator

Washington Healthplanfinder
(Online exchange marketplace)

Premium Pay
(Website where members can pay their premium online)

Small Groups

Plan Information and Brochures

Summary of Benefits and Coverage Requirements (PDF)

Getting Care with Core/Group Health Plans (PDF)

Getting Care with Access PPO Plans (PDF)

Service Area Map (PDF)

Compare Your Plan Options: 2017 Benefits (PDF)

Adult/Pediatric Dental Benefits (PDF)

Pediatric Dental Benefits (PDF)

Access PPO FAQ (PDF)

Glossary of Health Coverage and Medical Terms (PDF)

The Group Health Approach to Health Care (PDF)

Forms

Deductible & Out of Pocket Crediting Form (PDF)

Small Group Employer Application/Contract Renewal (PDF)

Employee Enrollment and Change Form (PDF)

Quote Request Form (PDF)

Waiver of Health Insurance Coverage (PDF)

Enrollment/Census Template (XLS)

Large Group

Plan Information and Brochures

Getting Care with Core/Group Health Plans (PDF)

Getting Care with Access PPO Plans (PDF)

Health Plan Funding Options (PDF)

Value Prop and Access PPO Flyer (PDF)

Provider Networks for Fully Insured Large Groups: New Sales and Renewals (PDF)

Access PPO Basic Summary Grid (PDF)

Access PPO Upfront Summary Grid (PDF)

Access PPO HSA Summary Grid (PDF)

Access PPO FAQ (PDF)

Access PPO Key Providers (PDF)

Self-Funded Overview of Core Services (PDF)

Self-Funded Overview of Reporting and Finance (PDF)

Wellness Solution Packages — RedBrick

RedBrick Worksite Wellness Program Overview Flyer (PDF)

Forms

Employee Enrollment and Change Form (PDF)

Group Master Application (PDF)

Census Template (XLS)

Medicare Advantage

Plan Information and Brochures

Medicare Advantage HMO Service Area (PDF)

Medicare Advantage Part D Comprehensive Formulary (PDF)

Medicare Advantage HMO Optional Dental Benefits (PDF)

Medicare Advantage HMO Plan Election Form (Northwest Counties) (PDF)

Medicare Advantage HMO Plan Election Form (Puget Sound) (PDF)

Medicare Advantage HMO Plan Election Form (Spokane County) (PDF)

Premium Pay
(Website where members can pay their premium online)

Population Health Management

Population Health Management Brochure (PDF) 

Wellness Solution

Wellness Solution Packages — RedBrick (PDF)

RedBrick Worksite Wellness Program (PDF)

Tips for a Successful Biometric Screening Event (PDF)

Employer Planning Checklist for Biometric Screening Event (PDF)

Biometric Screening Event Pricing Packages (PDF)

Occupational Health Services

Overview for Employers Flyer (PDF)

Injury Care at Group Health Medical Centers (PDF)

Occupational Health Locations Map (PDF)

Overview for Employers Website

Overview for Employees Website

Other Forms

Authorization to Disclose Health Plan Info (PDF) (Printable version)

Authorization to Disclose Health Plan Info (PDF) (Interactive version)

Benefit and Prescription Claim Form (PDF)

Important Disclosure Document (PDF)

Disclosure Information List (PDF)

Mail-Order Pharmacy Transfer Form (PDF)

Physician Selection/Change Form (PDF)