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 fax or mail.  EPK Benefits has an on-line portal for managing your BIIT account.  If you don’t have a login and would like access to the site, please e-mail your request to [email protected]

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, change address or change name:

BIIT Voluntary Life App is used by employees to apply for additional term life insurance coverage through the Trust.

Change Transmittal For All Trusts is used by employers to cancel employee or dependent coverage, or to update certain insurance information (i.e. address change).

Waiver For All Trusts 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.

BIIT Domestic Partner Packet is for groups interested in offering non-certified registered Employee Domestic Partner dependent coverage.

Forms can be sent to us via:

Fax: 425-641-8114


15375 SE 30th Place, Suite 380
Bellevue, WA 98007