Maddock and Associates
Insurance Specialists
Washington State
  Regence BlueShield
  Comprehensive Plans
    Breakthru 80
    Breakthru 70
  Catastrophic Plans
    Preferred Plan
    Selections
    Breakthru 50
  HSA Plans
    HSA Comprehensive
    HSA HealthPlan
  Plan Rates
  Apply Now!
  Provider Directory
  Waiting Period
    & Exclusions

  FAQ's

  LifeWise of WA
  HSA Plans
  Individual Dental

Washington State Group
  Group Medical
  Group Dental

Washington State Life
  Grp Life & Disability

Temporary Insurance
  About the Plan
  Premiums
  Application

Travel Insurance
  US Citizens
  Foreign Nationals
  Long Term

 


(Available to Washington State Residents Only)

Regence BlueShield Regence BlueShield Individual Medical
Application Process and Forms


There are now 2 ways to enroll in the Regence Plan
  1. Online Enrollment

    To Enroll On-Line – Click Here

  2. or

  3. Print and Mail Enrollment Forms


    1. Fill out the Application (one per family)
      Click here to download the Regence BlueShield Individual/Family Enrollment Application. Print the application and fill it out completely.

    2. Fill out the Questionnaire (one for each person to be covered)
      Click here to download the Standard Health Questionnaire for Washington State. Print and complete the questionnaire for each person to be covered on the plan. Please refer to Completing the Health Questionnaire to determine if this applies.

    3. Provide Proof of Washington State Residency
      To be eligible to purchase this plan you must be a Washington state resident.
      A photocopy of one of the following must accompany your application to prove residency:
      • Valid Washington State Driver's License or Identification Card
      • Washington State Voter Registration Card
      • Current Utility Bill in your name, including address

    4. Provide Certificate of Creditable Coverage (if available)
      Please refer to Credit for Prior Coverage & HIPPA Eligibility for more information. Please note, if you do not have your Certificate of Creditable Coverage at the time of application, please submit your application anyway. Credit for pre-existing condition waiting periods will be credited upon receipt of your Certificate of Creditable Coverage by Regence BlueShield.

    5. Do not Send a Payment
      Please do not send a rate payment with your application. You will receive a statement from Regence BlueShield upon acceptance of your application.
      If you would like to set up auto-pay via Electronic Funds Transfer, please
      click here to complete the Regence Preauthorized Bill Payment form. You may submit the Preauthorization Bill Payment form with your application.

    6. Send all Enrollment Materials to:
      Regence Blue Shield
      P.O. Box 1107
      1602 21st Ave
      Lewiston, ID 83501

Please note: Regence Blue Shield requires all COMPLETED enrollment materials to be postmarked to their office on or before the 20th of the month. Incomplete enrollments may cause delays in the effective date of your coverage. Please refer to the checklist on the application to avoid delays.

For Example: If you wanted your medical insurance coverage to begin on June 1, you would need to send all of the required, completed enrollment material to Regence Blue Shield postmarked on or before May 20.


E-mail us for more information and a free quote or CALL TOLL FREE
1-800-875-4490 (in the U.S.) or 1-253-854-0199 (outside the U.S.)
Fax: 1-253-896-9411


Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424
Serving all of Washington at 800-875-4490, Seattle at 206-682-1628,
Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291.
Copyright© 1998-2008, Maddock & Associates  |  Privacy Statement
Problems viewing this page? Contact the webmaster.


We Solve Problems
About UsContact UsHome