View & Print Forms

This page contains links to the claim forms available for printing. Click on the appropriate form to download, view, and print.

  Trust Enrollment Form
  Trust Plan Dental Claim Form
  Hearing Aid Claim Form
  Time Loss / Disability Waiver Form
  Family & Medical Leave Form
  Transition of Care Form-Regence
  Annual Affidavit of Qualifying Incapacitated Dependent Eligibility – Regence PDF
  Authorization to Release PHI Form
  Beneficiary Form
  > In order to view these PDF files you will need the Adobe Reader.