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Regence Blue Shield & Asuris Northwest Health Medical Forms
New Group Closed Case Requirements
Send sold cases to the TS&A office no later than 3 business days prior to the end of the month.
No Exceptions Please
For all groups:
  • Master Application
  • Individual Enrollment Forms/Waiver
  • First month premium check payable to Northwest Employers Trust
  • Group Health Questionnaire
  • Domestic Partner(if applicable)
  • Electronic Funds Transfer Agreement

Please Note: Regence will not process new business until all required paperwork is received.