Apply on Paper: Individual Coverage

Start by making sure you're eligible. Then decide which kind of coverage you want: medical, dental, or both. And the last step: print, complete and mail the forms in the box to the right.

In most cases, approved applications postmarked or delivered to us by the 20th day of the month will be considered effective on the first day of the following month.

Hints for the Medical Application

• Enrolling other family members? Fill out a separate health questionnaire (at right) for each person. All family members can use the same application if they are enrolling on the same plan.
   

• Select the deductible you want.
   
  
• Non-smoker? You might be eligible for a
  discount, so be sure to complete the
  certification statement on your application.
  
  
• Answer all questions so we can process
  your application without delay.
  

Questions?
Contact Asuris Northwest Health Consumer Sales at
1 (866) 704-2708 or e-mail us.