Skip to main content
Toggle search
Toggle navigation
In crisis?
Home
About HCA
Contact HCA
Home
Health care services and supports
Apple Health (Medicaid) coverage
Eligibility
Individual adults
Parents/Caretakers
Pregnant individuals
Children
Noncitizens
Aged, blind or disabled
Age 65 and older or Medicare eligible
Foster Care
Long-term services and supports (LTSS) and hospice
Medicare Savings Program
Benefits & services
Covered services
Autism & Applied Behavioral Analysis (ABA) therapy
Behavioral health and recovery
Dental services
Dual-Eligible Special Needs Plan (D-SNP)
Family Planning Only
Health Home
Immunizations
Interpreter services
Medically Intensive Children's Program (MICP)
Pharmacy services
Apple Health Second Opinion Program
Pregnancy services
First Steps (maternity and infant care)
First Steps provider directory
Chemical-Using Pregnant Women
Transhealth program
Transportation services (nonemergency)
Veterans and family members
Well-child checkups
Apply for or renew coverage
Use my coverage
American Indians and Alaska Natives (AI/AN)
Apple Health managed care
Apple Health coverage without managed care
Apple Health client booklets
Enrollment next steps
Make my first appointment
Apple Health account logins
Pay my Apple Health premium
Update my income or address (report a change)
Change my health plan
Replace my services card
Cancel my coverage
Forms & publications
Voices of Apple Health
Covered so she can care for herself and others
Health coverage provides whole-person care for family
Services you need, when you need it the most
Road to recovery found through supported employment
Family is covered when the unexpected happens
Pregnant mother finds comfort during uncertain times
Apple Health client inspired to help others access health coverage
Apple Health supported client while searching for job
Telehealth helps a mother connect with her child during pandemic
Foster parent helps kids get overdue medical care through Apple Health
After accident, hiker gets the care she needs through Apple Health
Apple Health worker helps ease financial worries of new mother
Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day
How a home and a job changed my life
Access to housing, employment, and health care gives Yakima resident a second chance
Cancer patient lives a quality life thanks to Apple Health
New mother and baby have healthy start thanks to Apple Health
Apple Health covers medically necessary surgery when other insurance wouldn’t
Apple Health leads the way to a better life for autism spectrum disorder (ASD) client
Apple Health for Kids provides relief for new parents
Access to health care allows student to pursue education stress-free
Children’s Health Insurance Program (CHIP) keeps health care affordable for families
Helping Apple Health (Medicaid) clients when they need it most
Apple Health gives life to those with chronic disease
Mother and daughter have a better life because of Apple Health
Apple Health provides otherwise unaffordable, life-saving medication for HIV patient
Apple Health outreach staff help spread the word about free and low-cost health insurance
Apple Health and community partners help improve the health of the Latino population in Washington
Apple Health brings stability to lives of young couple
I can’t begin to explain how much Apple Health has helped me
I wouldn’t be able to afford health insurance otherwise
We were not alone in this awful process
Getting the help I so desperately needed
Apple Health gives me a sense of security
Helping people navigate their way to Washington Apple Health
Apple Health has given her such peace of mind
Stakeholder training and education
Community-based training
Reference guides
Webinars, video, and presentations
Apple Health outreach toolkit
COFA outreach toolkit
Hospital Presumptive Eligibility
Medicaid suspension
Contact Washington Apple Health (Medicaid)
Behavioral health and recovery
American Indians and Alaska Natives (AI/AN)
Child and youth behavioral health services
Early signs of psychosis
Family initiated treatment (FIT)
Wraparound with Intensive Services (WISe)
Client rights
Behavioral health facility complaints
Ombuds services
Mental health services
Acute mental health care (inpatient)
Frequently asked questions (FAQs)
Mental health advance directives
Mental health crisis lines
Peer support
Problem gambling
Recovery support
Recovery residences
Substance use disorder prevention and mental health promotion
Substance use treatment
Alcohol use treatment
Opioid use treatment
Voices of behavioral health
Services you need, when you need it the most
Certified peer helps individuals find and keep housing
Road to recovery found through supported employment
Painful life lessons become strengths for crisis counselor
Integrated approach delivers all care “right here, right now”
Prescription assistance
Alternate help with prescriptions
Program Administration
Apple Health eligibility manual
General eligibility requirements that apply to all Apple Health programs
Classic (non-MAGI) based programs manual
Modified Adjusted Gross Income (MAGI) based programs manual
Long-term services and supports (LTSS) manual
Apple Health (Medicaid) manual WAC index
Coordination of benefits
Patient review and coordination
Premium payment program
News
Employee and retiree benefits
Public employees
Eligibility & enrollment
How to determine eligibility
Dependent eligibility
How to enroll
Dependent verification
Waiving medical coverage
Survivors
Medical plans & benefits
Benefits & coverage by plan
Compare medical plans
Behavioral health services by plan
Medical plans available by county
Kaiser Permanente NW plans
Kaiser Permanente WA plans
Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS
Health plans with health savings accounts (HSAs)
Dental plans & benefits
Compare dental plans
Additional benefits
Auto & home insurance
Dependent Care Assistance Program (DCAP)
Life insurance
Long-term disability insurance
Medical Flexible Spending Arrangement (FSA)
Plan discounts
Plan costs
Medical plan premiums
Life insurance premiums
Long-term disability insurance premiums
Paying for benefits
Surcharges
Tobacco use surcharge
Spousal coverage surcharge
Spousal plan questionnaire 2021
Spousal plan calculator
Medicare & PEBB benefits while employed
Benefits after layoff or separation
Frequently asked questions (FAQs)
Find a provider
Change your coverage
Cancel your coverage
Help with PEBB My Account login
Contact the plans
School employees
Eligibility & enrollment
How to determine eligibility
Dependent eligibility
How to enroll
Dependent verification
Waiving medical coverage
Survivors
Medical plans and benefits
Benefits and coverage by plan
Compare medical plans
Behavioral health services by plan
Medical plans by county
Kaiser Permanente NW
Kaiser Permanente WA
Premera
Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS
Health plans with health savings accounts (HSAs)
Dental plans and benefits
Compare dental plans
Vision plans and benefits
Compare vision plans
Additional benefits
Dependent Care Assistance Program (DCAP)
Life insurance
Long-term disability insurance
Medical flexible spending arrangement
Plan costs
Medical plan premiums
Life insurance premiums
Long-term disability insurance premiums
Paying for benefits
Surcharges
Tobacco use surcharge
Spousal coverage surcharge
Spousal plan questionnaire 2021
Spousal plan calculator
Medicare & SEBB benefits while employed
Frequently asked questions (FAQs)
Find a provider
Change your coverage
Cancel your coverage
Help with SEBB My Account login
Contact the plans
Retirees
Preparing for retirement
Attend a retirement webinar
Retiring from a DRS retirement plan
Employment ending without retirement
COBRA
Disability retirement
Separating employment: Plan 3 members
Higher-education retirement plan
Not participating in a Washington State-sponsored retirement plan
Eligibility & enrollment
How to determine eligibility
Dependent eligibility
How to enroll
Completing the retiree forms
Dependent verification
Deferring coverage
Survivors
Medical plans & benefits
Benefits & coverage by plan
Compare medical plans
Medical plans available by county
Kaiser Permanente NW plans
Kaiser Permanente WA plans
Medicare Supplement Plan G
Medicare Supplement Plan F
Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS
UnitedHealthcare
Health plans with health savings accounts (HSAs) (non-Medicare)
Dental plans & benefits
Compare dental plans
Additional benefits
Auto & home insurance
Life insurance
Plan discounts
Plan costs
Non-Medicare plan premiums
Medicare plan premiums
Life insurance premiums
Paying for benefits
Surcharges
Tobacco use surcharge
Spousal coverage surcharge
Spousal plan questionnaire 2021
Spousal plan calculator
Medicare & turning age 65
Frequently asked questions (FAQs)
Find a provider
Change your coverage
Cancel your coverage
Help with PEBB My Account login
Contact the plans
Continuation coverage
PEBB Continuation Coverage
Eligibility & enrollment
How to determine eligibility
Dependent eligibility
How to enroll
Dependent verification
Survivors
Medical plans & benefits
Benefits & coverage by plan
Compare medical plans
Medical plans available by county
Kaiser Permanente NW plans
Kaiser Permanente WA plans
Medicare Supplement Plan F
Medicare Supplement Plan G
Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS
UnitedHealthcare
Health plans with health savings accounts (HSAs) (non-Medicare)
Dental plans & benefits
Compare dental plans
Additional benefits
Auto & home insurance
Life insurance (unpaid leave only)
Long-term disability insurance (unpaid leave only)
Plan discounts
Plan costs
PEBB Continuation Coverage premiums (non-Medicare)
PEBB Continuation Coverage premiums (Medicare)
Life insurance premiums (unpaid leave only)
Long-term disability insurance premiums (unpaid leave only)
Paying for benefits
Surcharges
Tobacco use surcharge
Spousal coverage surcharge
Spousal plan questionnaire 2021
Spousal plan calculator
Frequently asked questions (FAQs)
Find a provider
Change your coverage
Cancel your coverage
Help with PEBB My Account login
Contact the plans
SEBB Continuation Coverage
Eligibility and enrollment
How to determine eligibility
Dependent eligibility
How to enroll
Dependent verification
Survivors
Medical plans and benefits
Benefits and coverage by plan
Compare medical plans
Behavioral health services by plan
Medical plans available by county
Kaiser Permanente NW plans
Kaiser Permanente WA plans
Premera plans
Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS
Health plans with health savings accounts (HSAs)
Dental plans and benefits
Compare dental plans
Vision plans and benefits
Compare vision plans
Additional benefits
Life insurance (Unpaid Leave)
Medical flexible spending arrangement
Plan costs
SEBB Continuation Coverage premiums
Life insurance premiums (Unpaid Leave)
Paying for benefits
Surcharges
Tobacco use surcharge
Spousal coverage surcharge
Spousal plan questionnaire 2021
Spousal plan calculator
Find a provider
Change your coverage
Cancel your coverage
Help with SEBB My Account login
Contact the plans
For groups joining the PEBB Program
How to join the PEBB Program
Employer groups and Educational Service Districts
School board members
Plan costs
Employer group monthly premiums
Educational Service Districts monthly premiums
School board member premiums
Rules & policies
PEBB rules and policies
SEBB rules and policies
Wellness programs
Diabetes prevention (PEBB)
Diabetes prevention (SEBB)
SmartHealth (PEBB)
SmartHealth (SEBB)
Living tobacco free (PEBB)
Living tobacco free (SEBB)
Public Employees Benefits Board (PEBB) Program
PEB Board
Schedules, agendas, & minutes
Archived agendas, minutes, & presentations
Enrollment
School Employees Benefits Board (SEBB) Program
Enrollment reports
File an appeal: PEBB
File an appeal: SEBB
Contact us
Forms & publications
News
Newsletters (PEBB)
Newsletters (SEBB)
Virtual benefits fair (PEBB)
For employees
Medical benefits
Kaiser Permanente Northwest
Kaiser Permanente of Washington
Uniform Medical Plan
Dental benefits
Delta Dental of Washington
Willamette Dental Group of Washington, Inc.
Additional benefits
Dependent Care Assistance Program (DCAP)
Life and accidental death and dismemberment (AD&D) insurance
Long-term disability (LTD) insurance
Medical Flexible Spending Arrangement (FSA)
SmartHealth wellness program
For retirees (enrolled in Medicare)
Medical benefits
Kaiser Permanente Northwest
Kaiser Permanente of Washington
Premera Blue Cross
Uniform Medical Plan
UnitedHealthcare
Dental benefits
Delta Dental of Washington
Willamette Dental Group of Washington, Inc.
Additional benefits
Life insurance
For retirees (not enrolled in Medicare)
Medical benefits
Kaiser Permanente Northwest
Kaiser Permanente of Washington
Uniform Medical Plan
Dental benefits
Delta Dental of Washington
Willamette Dental Group of Washington, Inc.
Additional benefits
Life insurance
SmartHealth wellness program
For PEBB Continuation Coverage - Unpaid Leave
Medical benefits
Kaiser Permanente Northwest
Kaiser Permanente of Washington
Uniform Medical Plan
Dental benefits
Delta Dental of Washington
Willamette Dental Group of Washington, Inc.
Additional benefits
Life and accidental death and dismemberment (AD&D) insurance
Long-term disability (LTD) insurance
Medical Flexible Spending Arrangement (FSA)
SmartHealth wellness program
For PEBB Continuation Coverage - COBRA (enrolled in Medicare)
Medical benefits
Kaiser Permanente Northwest
Kaiser Permanente of Washington
Premera Blue Cross
Uniform Medical Plan
UnitedHealthcare
Dental benefits
Delta Dental of Washington
Willamette Dental Group of Washington, Inc.
For PEBB Continuation Coverage - COBRA (not enrolled in Medicare)
Medical benefits
Kaiser Permanente Northwest
Kaiser Permanente of Washington
Uniform Medical Plan
Dental benefits
Delta Dental of Washington
Willamette Dental Group of Washington, Inc.
Additional benefits
SmartHealth wellness program
Virtual benefits fair (SEBB)
Medical benefits
Kaiser Permanente Northwest
Kaiser Permanente of Washington
Kaiser Permanente of Washington Options
Premera Blue Cross
Uniform Medical Plan
Dental Benefits
Delta Dental of Washington
Willamette Dental Group of Washington, Inc.
Vision Benefits
Davis Vision, Inc.
EyeMed
MetLife Vision Program
Dependent Care Assistance Program (DCAP)
Life and accidental death & dismemberment (AD&D) insurance
Long-term disability (LTD) insurance
Medical Flexible Spending Arrangement (FSA)
SmartHealth wellness program
Billers, providers, and partners
Washington Apple Health (Medicaid) providers
Enroll as a provider
Eligible provider types and requirements
Enroll as a billing provider
Enroll as a health care professional practicing under a group or facility
Enroll as a nonbilling provider
Enroll as a billing agent/clearinghouse
Next steps for new Medicaid providers
Existing Apple Health (Medicaid) providers
Revalidation
Provider termination and exclusion list
Prior authorization, claims, and billing
Getting started
Document submission cover sheets
Request a Zoom license to connect with patients (during the COVID-19 pandemic)
Prior authorization (PA)
Claims and billing (guides/fee schedules)
Provider billing guides and fee schedules
Hospital reimbursement
HIPAA Electronic Data Interchange (EDI)
Indian health programs
Audit and Medicaid program integrity
ProviderOne resources
ProviderOne Billing and Resource Guide
ProviderOne user manuals
ProviderOne for social services
ProviderOne Security
Fact sheets
Webinars
ProviderOne maintenance
ProviderOne Discovery Log
Programs & services
Program benefit packages and scope of services
Patient review and coordination (PRC)
340B Drug Pricing Program
Autism and Applied Behavior Analysis (ABA) therapy
Behavioral health and recovery
American Indians and Alaska Natives (AI/AN)
Become a behavioral health provider
Child & youth behavioral health services
Early psychosis
Family initiated treatment (FIT)
Wraparound with Intensive Services (WISe)
Contractor & provider resources
Medicaid documentation support
Service Encounter Reporting Instructions (SERI)
TARGET
Designated crisis responders (DCR)
Intensive Residential Treatment (IRT) Teams
Partnership Access Lines (PAL)
Peer support
Preadmission Screening & Resident Review (PASRR)
Program of Assertive Community Treatment (PACT)
Substance use disorder prevention and mental health promotion
Substance use treatment
Alcohol use treatment
Medications for opioid use disorder (MOUD)
Opioid treatment programs (OTPs)
Screening, brief intervention, and referral to treatment (SBIRT)
Screening
Brief interventions
Motivational interviewing
Referrals to treatment
Suicide prevention resources
Dental services
Durable medical equipment (DME)
Family planning
First Steps (maternity and infant care)
Foster Care
Health Home
Health Home resources
Ground emergency medical transportation (GEMT)
Interpreter services
Sign language interpreters
Spoken language interpreters
Kidney Disease Program (KDP)
Managed care
Model managed care contracts
Resources
Medicaid Administrative Claiming (MAC)
Department of Corrections (DOC)
King County Superior Court Juvenile Probation Services
Local Health Jurisdictions
Public school districts
Washington State Federally Recognized Tribes
Pharmacy
Apple Health (Medicaid) drug coverage criteria
Apple Health Preferred Drug List (PDL)
Apple Health Second Opinion Program
Become an endorsing practitioner
Opioids
Pharmacy prior authorization
School-based health care services (SBHS)
Substance use disorder (SUD) consent management guidance
Transhealth program
Transportation services (nonemergency)
News
Provider Alerts
Provider Alerts 2020
Provider Alerts 2019
Provider Alerts 2018
Provider Alerts 2017
Provider Alerts 2016
Provider Alerts 2015
Provider Notices 2014
Contact us
Forms & publications
About HCA
Programs & initiatives
Apple Health (Medicaid)
What we're working on
Lifeline phone services
COFA Islander programs
1095-B tax form
Rate increase for pediatric primary care
Adult hearing benefit
Apple Health for You
SUPPORT Act
Consumer notices workgroup
News
How we work
Related laws and rules
Medicaid (Title XIX) State Plan
Medicaid Title XIX Advisory Committee
What is the State Plan?
Approved State Plan Amendments
2021
2020
2019
2018
2017
2016
2015
2014
Reports
Contact Apple Health (Medicaid)
Behavioral health and recovery
What we're working on
Block grants
The Center of Parent Excellence (COPE) project
Children's Long-term Inpatient Program (CLIP)
Ricky’s Law: Involuntary Treatment Act (ITA)
State Opioid Response (SOR) grant
State Opioid and Overdose Response (SOOR) plan
State v. Blake: ESB 5476 and behavioral health expansion
Substance use disorder prevention and mental health promotion
Washington State Hub and Spoke Project
Partners
Behavioral Health Advisory Council
Children and Youth Behavioral Health Work Group (CYBHWG)
Meetings
Members
Events and training
Resources
Reports
Family Youth System Partner Round Table (FYSPRT)
Office of Recovery Partnerships
Peer respites
Problem Gambling Task Force (PGTF)
Reports
Evidence-based and research-based practices
Mental health reports
Wraparound with Intensive Services (WISe)
Cascade Care
What we're working on
Clinical collaboration and initiatives
What we're working on
Bree Collaborative
Eliminating hepatitis C
Emerging Therapies Workgroup
Opioid crisis
Prescription drug price transparency
How we work
Partners
Contact us
Health Information Technology
What we're working on
Electronic health records (EHR) as a service
How we work
News
Newsletters
Resources
Clinical Data Repository
Promoting Interoperability Program (PIP)
Washington State Medicaid HIT plan
Contact us
Health Technology Assessment
What we're working on
Health technology reviews
Topic selection
Health Technology Clinical Committee
Clinical experts
Committee members
Recruitment
How we work
Technology selection
Key questions
Evidence report
Coverage decision and meeting
Decision complete
Tracking success
How to participate
Meetings and materials
Contact us
Making informed health care decisions
Palliative care
Hospice
End of life care
Shared decision making
Patient decision aids (PDAs)
Medicaid Transformation Project (MTP)
What we're working on
The future of MTP
MTP renewal
One year extension and amendment
Initiative 1: transformation through ACHs and IHCPs
ACH submitted documents
Medicaid Transformation metrics
Initiative 2: long-term services & supports
Initiative 3: Foundational Community Supports (FCS)
Foundational Community Supports (FCS) resources
Initiative 4: substance use disorder (SUD) IMD
Initiative 5: mental health IMD
News
Partners
Accountable Communities of Health (ACHs)
Better Health Together
Cascade Pacific Action Alliance
Elevate Health
Greater Columbia ACH
HealthierHere
North Central ACH
North Sound ACH
Olympic Community of Health
SWACH
Indian health care providers (IHCPs)
Tracking success
Analytics, Research, and Measurement (ARM)
ARM data dashboards
Meetings & materials
Resources
Events
Learning Symposium (2021)
Reports
State Innovation Models (SIM) grant reports
Public Employees Benefits Board (PEBB) Program
What we're working on
1095-C tax form
How we work
News
Operations
How to participate
Meetings & materials
Related laws & rules
Reports
Contact us
School Employees Benefits Board (SEBB) Program
Operations
Meetings and materials
News
SEBB fact sheets
Reports
Trauma-informed approach
What we're working on
News
How to participate
Resources
Tribal Affairs
Consultations and meetings
Health care coverage
Resources
What we're working on
Apple Health (Medicaid) quality strategy and compliance oversight
Apple Health (Medicaid) MCO and BH-ASO state contracts
Revised Indian Nation agreements and program agreements
Governor's Indian Health Advisory Council
Medicaid Transformation
Nonemergency medical transportation (NEMT) contracts
Primary care case management (PCCM) contracts
Contact us
Uniform Medical Plan (UMP)
What we're working on
Centers of Excellence
Partners
How to participate
Resources
Value-based purchasing (VBP)
What we're working on
Advancing VBP
Rural transformation
Multi-payer Primary Care Transformation Model
News
Meetings and materials
Partners
Tracking success
Resources
Washington Prescription Drug Program (WPDP)
How we work
Partners
Tracking success
Participants
How to participate
Become an Endorsing Practitioner
Meetings and materials
Related laws and rules
Reports
Contact us
Washington Wellness
Resources
Build a wellness program
SmartHealth for PEBB
SmartHealth for SEBB
Diabetes prevention for PEBB
Diabetes prevention for SEBB
Living tobacco free for PEBB
Living tobacco free for SEBB
Healthy Worksite Summit
Healthy eating
Physical activity
Flu shot clinics
Health fairs
Lunch & learn lectures
Employee Assistance Program (EAP)
Find a wellness coordinator
More resources
How we work
Tracking success
Meetings & materials
Reports
Contact us
Who we are
Our leadership
Our mission, vision, and values
Health equity
Boards, committees, and collaboration
Health Care Cost Transparency Board
Board members
Meetings & materials
Advisory Committee of Health Care Providers and Carriers
Advisory Committee on Data Issues
Advisory committee members
Universal Health Care Work Group
Resources
Performance measures
Washington Statewide Common Measure Set
Health care reform
Work with us
Careers at HCA
Bids and contracts
Voices of HCA
HCA connects employee ambitions with career goals
HCA hosts Camo2Commerce Work Ex intern
Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple
Celebrating HCA’s nurses during National Nurses Week, May 6-12
Community based specialists help people with free or low-cost health care coverage
Introducing new HCA Director Sue Birch
Military experiences shape personal and professional values
Artist turned graphic designer helps HCA create and maintain hundreds of print and web products
Infants at the Workplace Program provides support and flexibility for new parents
Around the world at HCA
HCA goes ‘above and beyond’ for employees with disabilities
Black History Month celebration was a first at HCA
News, data, and reports for HCA
Information about novel coronavirus (COVID-19)
News releases
Press room
HCA Connect blog
Public notices
Data & reports
Apple Health (Medicaid) and managed care reports
Client eligibility data dashboard
Provider data dashboard
Behavioral health and recovery
Budget information
Dental data
Legislative reports
Interpreter services dashboard
Public Employees Benefits Board (PEBB) Program enrollment
Reproductive health
School Employees Benefits Board (SEBB) Program enrollment
Washington State All Payer Claims Database (WA-APCD)
Announcements
Connect with us
Rules
Rulemaking
General Health Care Authority rulemaking
Apple Health (Medicaid) rulemaking
Behavioral health and recovery rulemaking
Public Employees Benefits Board rulemaking
School Employees Benefits Board rulemaking
Upcoming public hearings
Rule notices
Rule notices 2020
Rule notices 2019
Rule notices 2018
Rule notices 2017
Appeals
File an appeal: Apple Health (Medicaid)
File an appeal: PEBB
Board of Appeals
Significant decisions
File an appeal: SEBB
Policies
Accessibility
Interpreter services
Language access
Nondiscrimination statement
Notice of privacy practices
HCA notice of privacy practices
UMP notice of privacy practices
Website privacy policy
Administrative
Disaster outreach
Fraud prevention
Gender identity information
Legislative relations
Log in (HCA employees/vendors)
Medicaid program integrity
Activities and oversight
Partners
Resources
Contact us
Personal injury, casualty recoveries, & special needs trusts
Public disclosure requests
Voter registration
Contact HCA
SEBB Benefits Administrators
Employee eligibility tools and worksheets
Employee life circumstances
Employees
Newly eligible employees
When coverage ends
Separation (employment ending)
Dependents
Appeals process
Continuation coverage
Quick reference guides and training
Quick reference guides
Medicare secondary payer (MSP)
Training schedule
Training materials
Manuals
FAQs for school administrators
Laws, rules, and policies
Benefits, rates, and reporting
Medical
Vision
Dental
Additional benefits
Rates information
Forms and publications
Notices and updates
Find answers (FUZE)
Contact us
Announcement Menu
Home
Apple Health Eligibility Manual
Home
Search
Close menu
Search form
Search all of HCA
Search Health care services and supports
Search Billers, providers, & partners
Search Employee & retiree benefits
Search About HCA
Search
Home
About HCA
Contact HCA
In crisis?
Home
Employee and retiree benefits
Forms and Publications
Employee and retiree benefits
Forms & publications
News
Wellness
PEB Board
SEB Board
Rules & policies
Contact
Search
Customer Type
All customer types
Public employee
School employee
Retiree
Continuation coverage
Groups joining PEBB
Employer Groups
Document Type
All Document Types
Criteria of coverage
Fact sheet
Fee schedule
Form
Newsletter
Publication
Topic
- Any -
Appeals
Certificate of coverage
Continuation coverage
COVID-19
Data product
Dental
Dependent Certification
Drug Utilization Review Board
Eligibility
Employee
Enrollment
Health Home
K12/employer groups
Life insurance
Long Term Disability insurance
Medical benefits
Medicare
Member forms
Member survey
Newsletter
Non-Medicare
Pharmacy and Therapeutic Committee
Preauthorization criteria
Preferred drug list
Premium Surcharges
Prescription drugs
ProviderOne
Public Employees Benefits Board
Rates
Retiree
School Employees Benefits Board
Summary of benefits
Vision
Wellness
Year
All Years
2018
2019
2020
2021
2022
Plan
- Any -
Davis
Delta Dental
EyeMed
KPNW
KPWA
KPWA Options
MetLife
Premera
Premera Supplemental Plan
Standard
UMP
UnitedHealthcare
Willamette Dental Group
Sort by
Name (A-Z)
Name (Z-A)
Search
Reset filters
Medicare Advantage Plan Election Form (form C) 2021
51-0576
Use this form to enroll in Medicare Advantage plans.
Form
Get Form
Medicare Advantage Plan Election Form (form C) 2021
PDF
In crisis?