BIAW Trust PDF Forms
The following forms are provided for your convenience. They are saved in PDF format (requires the free Adobe Acrobat Reader) and can be printed from your computer. They can be sent to us by scan/email, fax, or mail.
Employee/Subscriber Application: select from the options below (please note: this form is 2 pages):
This form is filled out by each eligible employee or owner as well as the group administrator. This form is used for initial enrollment, for adding new employees, to add a dependent, to change a beneficiary, to change a medical plan during an open enrollment period, change address and change name:
- BIAW Regence BlueShield or Kaiser Permanente
- BIAW Asuris Northwest or Kaiser Permanente
- BIAW Voluntary Dental and/or Vision
BIAW Voluntary Life Insurance Form is used by employees to apply for voluntary term life insurance coverage through the Trust.
BIAW Change Transmittal Form is used by employers to cancel employee or dependent coverage, or to update certain insurance information (i.e. address change).
Employee Waiver of Insurance Form is used by employees when an otherwise eligible employee wants to decline or waive enrollment in the Trust program due to other health insurance coverage.
Domestic Partner Packet for groups interested in offering non-state registered Employee Domestic Partner dependent coverage.
Forms can be sent to us via:
Scan & Email: email@example.com
15375 SE 30th Place, Suite 380
Bellevue, WA 98007