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Title | Download | Online Form | States |
---|---|---|---|
Accident Claim Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Accidental Death & Dismemberment Employee Flyer | Download Form | AK, CA, MT, OR, UT, WA, WY | |
Accidental Death & Dismemberment Employee Flyer - ID | Download Form | ID | |
Accidental Dismemberment Claim Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
ADA Dental Claim Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Affidavit of Non-State Certified Domestic Partnership | Download Form | OR | |
Affidavit of Non-State Registered Domestic Partnership | Download Form | WA | |
Affidavit of Qualified Disabled Dependent | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Affidavit of Qualifying Domestic Partnership | Download Form | AK, CA, ID, MT, UT, WY | |
Agent Standard Commission Schedule - AK | Download Form | AK | |
Agent Standard Commission Schedule - CA | Download Form | CA | |
Agent Standard Commission Schedule - MT, WY | Download Form | MT, WY | |
Agent Standard Commission Schedule - OR, ID, UT | Download Form | ID, OR, UT | |
Agent Standard Commission Schedule - WA | Download Form | WA | |
Assignment of Life Insurance Proceeds Form for Life Claim Benefits | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Authorization for LifeMap to Release Information | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Beneficiary Designation Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Billing FAQ | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Cancer Only Critical Illness Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Cancer Only Critical Illness Employee Flyer - ID | Download Form | ID | |
Cancer Plus Critical Illness Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Cancer Plus Critical Illness Employee Flyer - ID | Download Form | ID | |
Critical Illness Cancer Care Claim Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Dental Health Article for Employees | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Dental Overview for Employers 2-299 | Download Form | AK, MT, OR, UT, WA, WY | |
Dental Overview for Employers 300+ | Download Form | AK, MT, OR, UT, WA, WY | |
Dental Overview for ID Employers 2-299 | Download Form | ID | |
Dental Overview for ID Employers 300+ | Download Form | ID | |
Dental Voluntary Group Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Dental Waiver Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Direct Deposit Form for Claim Benefits | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Employer Admin Center User Guide and FAQ | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Employer Admin Guide | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Encuentre un dentista | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Encuentre un oculista | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Evidence of Insurability (EOI) Frequently Asked Questions | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Evidence of Insurability (EOI) with HIPAA Authorization | Download Form | Online Form | AK, ID, MT, OR, UT, WA, WY |
Extended Life Insurance Claim Form for Employee | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Extended Life Insurance Claim Form for Spouse | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Find a Dentist | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Find a Vision Provider - Group | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Folleto de accidente para empleados | Download Form | ID, MT, OR, UT, WA, WY | |
Folleto de Cáncer Plus (Enfermedad grave) para empleados | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Folleto de Cobertura dental colectiva para empleados | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Folleto de Cobertura dental voluntaria para empleados | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Folleto de Discapacidad de corto plazo para empleados | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Folleto de Discapacidad de largo plazo para empleados | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Folleto de muerte accidental y desmembramiento | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Folleto de Única cáncer (Enfermedad grave) para empleados | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Folleto de Vida colectiva para empleados | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Folleto de Vida voluntaria para empleados | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Formulario de Evidencia de Asegurabilidad con Autorización HIPAA | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Group Dental Employee Flyer | Download Form | AK, CA, MT, OR, UT, WA, WY | |
Group Dental Employee Flyer - ID | Download Form | ID | |
Group Products Overview 10+ | Download Form | AK, MT, OR, UT, WA, WY | |
Group Products Overview 10+ CA | Download Form | CA | |
Group Products Overview 10+ ID | Download Form | ID | |
Group Products Overview Express 2-9 CA | Download Form | CA | |
HIPAA Authorization to Disclose Protected Health Information | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Individual Critical Illness and Emergency Treatment Benefit Claim Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Individual Dental Enrollment Packet - ID | Download Form | ID | |
Individual Dental Enrollment Packet - OR | Download Form | OR | |
Individual Dental Enrollment Packet - UT | Download Form | UT | |
Individual Dental Enrollment Packet - WA | Download Form | WA | |
Individual Dental Member Brochure - ID | Download Form | ID | |
Individual Dental Member Brochure - OR | Download Form | OR | |
Individual Dental Member Brochure - UT | Download Form | UT | |
Individual Dental Member Brochure - WA | Download Form | WA | |
Individual Dental Rates 4/1/2023 to 6/30/2023 - ID | Download Form | ID | |
Individual Dental Rates 4/1/2023 to 6/30/2023 - OR | Download Form | OR | |
Individual Dental Rates 4/1/2023 to 6/30/2023 - UT | Download Form | UT | |
Individual Dental Rates 4/1/2023 to 6/30/2023 - WA | Download Form | WA | |
Individual Dental Rates 7/1/2023 to 9/30/2023 - ID | Download Form | ID | |
Individual Dental Rates 7/1/2023 to 9/30/2023 - OR | Download Form | OR | |
Individual Dental Rates 7/1/2023 to 9/30/2023 - UT | Download Form | UT | |
Individual Dental Rates 7/1/2023 to 9/30/2023 - WA | Download Form | WA | |
Individual Short Term Medical Pharmacy Reimbursement Form | Download Form | ID, OR, UT, WA | |
Individual Vision Rider Reimbursement Form | Download Form | ID, OR, UT | |
Initial Premium Invoice | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Inscribirse en el Centro Dental de LifeMap | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
La hoja de trabajo del seguro de vida | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
La hoja de trabajo del seguro por discapacidad | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Life Conversion Request for Information Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Life Employee Flyer | Download Form | AK, CA, MT, OR, UT, WA, WY | |
Life Insurance Claim Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Life Insurance Worksheet | Download Form | AK, CA, MT, OR, UT, WA, WY | |
Life Insurance Worksheet - Idaho | Download Form | ID | |
LifeMap Advantages Member Flyer | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
LifeMap Enrollment Change Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
LifeMap Protect 10 Benefit Summary | Download Form | ID, OR, UT, WA | |
LifeMap Protect 20 Benefit Summary | Download Form | ID, OR, UT, WA | |
LifeMap Protect 30 Benefit Summary | Download Form | ID, OR, UT, WA | |
LifeMap Protect Plans Flyer | Download Form | ID, OR, UT, WA | |
Long Term Disability Claim Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Long Term Disability Employee Flyer | Download Form | AK, CA, MT, OR, UT, WA, WY | |
Long Term Disability Employee Flyer - ID | Download Form | ID | |
Notice of Privacy Practices - STM, Vision, Dental | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Privacy Notice | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Regence Life Solutions Life 10 Benefit Summary | Download Form | ID, OR, UT, WA | |
Regence Life Solutions Life 20 Benefit Summary | Download Form | ID, OR, UT, WA | |
Regence Life Solutions Life 30 Benefit Summary | Download Form | ID, OR, UT, WA | |
Risk Evaluation Form | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Short Term Disability Claim Form | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Short Term Disability Claim Form - Employee's Statement | Online Form | AK, ID, MT, OR, UT, WA, WY | |
Short Term Disability Overview for Employers | Download Form | AK, MT, OR, UT, WA, WY | |
Short Term Disability Overview for ID Employers | Download Form | ID | |
Small Group (10-25 Employees) Basic Life and AD&D Benefit Summary | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group (10-25 Employees) Dental Plan J Benefit Summary | Download Form | ID, OR, UT, WA | |
Small Group (10-25 Employees) Dental Plan K and L Benefit Summary | Download Form | ID, OR, UT, WA | |
Small Group (10-25 Employees) Dental Plan Options | Download Form | ID, OR, UT | |
Small Group (10-25 Employees) LTD Benefit Summary | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group (10-25 Employees) Master Application | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Small Group (10-25 Employees) STD Benefit Summary | Download Form | AK, ID, MT, OR, UT, WY | |
Small Group (10-25 Employees) Voluntary Life and AD&D Benefit Summary | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group (10-25 Employees) Washington Dental Plan Options (Active PPO Plans) | Download Form | WA | |
Small Group (10-25 Employees) Washington Dental Plan Options (Passive PPO Plans) | Download Form | WA | |
Small Group (2-25 Employees) Implementation Worksheet | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Small Group (2-25 Employees) Service Directory | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Small Group (2-25 Employees) Vision Benefit Summary - $130 Frame Allowance | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group (2-25 Employees) Vision Benefit Summary - $150 Frame Allowance | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group (2-25 Employees) Washington Dental Plan L with TMJ Benefit Summary | Download Form | WA | |
Small Group (2-9 Employees) Basic Life and AD&D Benefit Summary | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group (2-9 Employees) Dental Plan A Benefit Summary | Download Form | ID, OR, UT | |
Small Group (2-9 Employees) Dental Plan C Benefit Summary | Download Form | ID, OR, UT | |
Small Group (2-9 Employees) Dental Plan Options | Download Form | ID, OR, UT | |
Small Group (2-9 Employees) LTD Benefit Summary | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group (2-9 Employees) Master Application | Download Form | AK, CA, ID, MT, OR, UT, WA, WY | |
Small Group (2-9 Employees) STD Benefit Summary | Download Form | AK, ID, MT, OR, UT, WY | |
Small Group (2-9 Employees) Voluntary Life and AD&D Benefit Summary | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group (2-9 Employees) Washington Dental Plan J Benefit Summary | Download Form | WA | |
Small Group (2-9 Employees) Washington Dental Plan K Benefit Summary | Download Form | WA | |
Small Group (2-9 Employees) Washington Dental Plan L Benefit Summary | Download Form | WA | |
Small Group (2-9 Employees) Washington Dental Plan Options | Download Form | WA | |
Small Group (5-9 Employees) Washington Dental Plan L with Ortho Benefit Summary | Download Form | WA | |
Small Group Basic Life and AD&D Plan Options | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group LTD Plan Options | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group STD Plan Options | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group Vision Plan Options | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Small Group Voluntary Life and AD&D Plan Options | Download Form | AK, ID, MT, OR, UT, WA, WY | |
STM Authorization For Use and Disclosure of Protected Health Information | Download Form | ID, OR, UT, WA | |
Vision Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Vision Employee Flyer - ID | Download Form | ID | |
Vision Employee Waiver Form | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Vision Out of Network Reimbursement Form | Download Form | AK, ID, MT, OR, UT, WA, WY | |
Voluntary Accident Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Voluntary Accident Employee Flyer - ID | Download Form | ID | |
Voluntary Accidental Death & Dismemberment Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Voluntary Accidental Death & Dismemberment Employee Flyer - ID | Download Form | ID | |
Voluntary Group Dental Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Voluntary Group Dental Employee Flyer - ID | Download Form | ID | |
Voluntary Life Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Voluntary Life Employee Flyer ID | Download Form | ID | |
Voluntary Long Term Disability Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Voluntary Long Term Disability Employee Flyer - ID | Download Form | ID | |
Voluntary Short Term Disability Employee Flyer | Download Form | AK, MT, OR, UT, WA, WY | |
Voluntary Short Term Disability Employee Flyer - ID | Download Form | ID | |
Wellness Benefit Statement | Download Form | AK, CA, ID, MT, OR, UT, WA, WY |