How to Enroll
1. Complete the
application in full.
Missing information may cause your effective date
to be delayed. (If you have more than four children, please attach a
separate list)
2. Calculate the
premium. Be
sure to select a monthly or quarterly payment schedule.
Include the applicable payment for the first month
or quarter of coverage, according to the payment schedule you have selected.
Please make the check payable to Regence Life & Health.
3. Send the application and your
check or money order made payable to Regence Life & Health
Insurance Company to:
Green Financial
PO Box 8036
Kirkland, WA 98034
Notes:
You may enroll for Child Only coverage.
If you are enrolling children only, a separate
application must be completed and submitted for each child.
If you are enrolling a non-state
certified domestic partner, please complete the
affidavit.
If you are not satisfied with this
policy, you may return the policy within 10 days of delivery for a full
refund of premium. An additional 10% penalty will be added to any
premium refund due that is not paid within 30 days of return of policy to
the insurer or agent.
Questions? 800-877-8019
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