Apply for Coverage

  • It’s easy. Your client can apply either online or by mail.

    Online Enrollment

    Your clients can apply using your own personal enrollment link. Applying online allows you to track your clients current status of their application.

    If you do not have a personal enrollment link please call Producer Support at 877-205-9725, Option 1.

    To Apply By Mail

    For effective dates starting January 1, 2014

    Starting January 1, 2014, applicants will only need to complete the application to apply for coverage as required by the Affordable Care Act (ACA) 

    1. Download and complete the application form:
      Individual and Family Application One application per family
    2. Then mail to:
      Premera Blue Cross
      PO Box 91120, MS 295
      Seattle, WA 98111-9220

    Applying through Washington Healthplanfinder?

    If your clients qualify for premium credit assistance, cost share reduction plans or American Indian/Alaska Native plans, they will want to enroll in a plan through Washington Healthplanfinder.

    Is Your Client Eligible to Apply?

    Eligibility Considerations

    Individuals eligible to apply for a Premera plan must be:

    • A resident of and have a principal residence in the state of Washington
    • Not entitled to Medicare. If 65 or older but not eligible for Medicare, the applicant must submit a “Not eligible for Medicare” document from the Social Security Administration
    • Applying during an open enrollment period or due to a qualifying event

    Eligible dependents that can enroll on a plan include:

    • Spouse or domestic partner
    • Natural or legally adopted child(ren) under the age of 26

    Open Enrollment Periods

    The open enrollment period this year is October 1, 2013 – March 31, 2014. Your client can select a new plan during this period. If they do not enroll during this period, they’ll have to wait until November 15, 2014, to change their plan or purchase coverage for January 1, 2015.

    Your Sales Executive and Producer Support are available to help answer any questions you might have about these plans.

    Grandfathered plans

    Your clients can retain their grandfathered plans (established prior to March 23, 2010) or select a new plan. If a grandfathered client wants to select a new plan, they'll have until March 31, 2014. After that, they will need to wait until November 15, 2014, to change plans for a January 1, 2015, effective date.

    Qualifying Events

    Individuals are eligible to apply for coverage outside of the annual open enrollment period only when they have a qualifying event.

  • Application and supporting documentation must be received within 60 days of the qualifying event.

    For birth of child to policyholder or enrolled spouse, submit:

    • Copy of the birth certificate or temporary certificate from the hospital

    For placement for adoption or adoption of the applicant for whom coverage is sought, submit:

    • Copy of the adoption papers

    For a child placed in foster care, as a legal ward, or for medical support orders (for Qualified Health Plans), submit one of the following:

    • Copy of the foster care papers,
    • Copy of the medical support order, or
    • Copy of the court order appointing a guardian

    Application and supporting documentation must be submitted within 60 days of the qualifying event.

    For loss of COBRA benefits because the COBRA coverage period has ended (usually after 18 months) or the individual has exceeded the lifetime limit in the plan, and no other COBRA coverage is available, submit:

    • Letter from employer or COBRA administrator indicating loss of COBRA coverage due to individual exhausting the COBRA period, and that no other COBRA coverage is available, or
    • Letter from employer or COBRA administrator indicating the individual has exceeded the lifetime limit in the plan, and that no other COBRA coverage is available

    Note: Voluntary termination of COBRA is not a qualifying event. If you terminate or stop paying for your COBRA, you must wait for the next open enrollment period to apply.

    Application and supporting documentation must be submitted within 60 days of the qualifying event:

    If COBRA coverage has been exhausted due to failure of the employer to remit premium, submit:

    • Letter from employer or COBRA administrator indicating loss was due to failure of the employer to remit premium

    Application and supporting documentation must be submitted within 60 days of event:

    For loss of coverage as a dependent on a group plan due to age, submit

    • Letter from employer or insurance health plan indicating loss of coverage due to age

    Application and supporting documentation must be submitted within 60 days of the qualifying event:

    For individuals who lost coverage in a qualified health plan by the health benefit exchange pursuant to 45 C.F.R. 155.430 and the three-month grace period for continuation of coverage has expired, submit:

    • Letter from the Exchange indicating coverage was discontinued by the Exchange and the three-month grace period for continuation of coverage has expired

    Application and supporting documentation must be submitted within 60 days of the qualifying event:

    For loss of coverage due to divorce, dissolution of marriage, or termination of domestic partnership submit

    • Copy of your divorce decree, or
    • Copy of your annulment paperwork
    • A statement (including the date) noting when the Domestic Partnership ended, AND 
    • A letter from the prior health plan

    Application and supporting documentation must be submitted within 60 days of the qualifying event.

    For loss of employer-sponsored coverage, submit:

    • Copy of your COBRA letter, or 
    • A letter from your employer listing each applicant who experienced a loss of coverage, AND reason for termination of health coverage

    Application and supporting documentation must be submitted within 60 days of the qualifying event:

    • A letter from the Exchange, health plan, or HHS indicating coverage was lost due to an error

    Application and supporting documentation must be received within 60 days of the qualifying event.

    If you have recently married or entered domestic partnership, submit one of the following, with both names clearly listed:

    • Copy of the marriage certificate
    • Copy of the state registration
    • Copy of the utility bill
    • Copy of the declaration of domestic partnership, or
    • Copy of the lease or car title

    Application and supporting documentation must be submitted within 60 days of the qualifying event:

    For a loss in Medicaid or other public program providing health benefits, submit:

    • Copy of your Medicaid letter indicating ineligibility or loss of coverage, or 
    • Copy from the public program indicating ineligibility or loss of coverage

    Application and supporting documentation must be submitted within 60 days of the qualifying event:

    For loss of minimum essential coverage including loss of employer-sponsored insurance coverage (except for voluntary termination, misrepresentation, or fraud) submit:

    • Your COBRA offer letter, or
    • A letter from your employer listing each applicant who experienced a loss of coverage AND 
    • Reason for termination of health coverage

    Application and supporting documentation must be submitted within 60 days of the qualifying event.

    If there is a situation in which a plan no longer offers benefits to the class of similarly situated individuals that includes the applicant, submit:

    • A letter from the prior health plan indicating loss of coverage due to not being in a class of similarly situated individuals

    Application and supporting documentation must be submitted within 60 days of the qualifying event.

    If a Qualified Health Plan substantially violated a material provision of its policy, submit:

    • Evaluation and determination documentation from Washington Healthplanfinder

    Application and supporting documentation must be submitted within 60 days of the qualifying event.

    For loss in coverage due to permanent change in residence, work, or living situation where your prior health plan does not provide coverage in your new service area, submit:

    • Documentation such as a utility bill or rental or lease agreement showing prior address and new address, and 
    • A verification letter from your prior health plan indicating a loss of coverage

    Application and supporting documentation must be submitted within 60 days of the qualifying event.

    • A letter from the insurance health plan or school indicating a loss of coverage

    Application and supporting documentation must be submitted within 60 days of the qualifying event.

    • A letter from WSHIP indicating coverage has been discontinued