Enrollment Instructions - Two Ways to Enroll

1. The fastest way to enroll is to apply online:

Step 1:  Click on the "Begin Shopping" button to start the online enrollment process. 

Step 2:  Enter your ZIP code and who the coverage is for and then click on "Get Quote".

Step 3:  Click on the "Learn More" button for the plan you are applying for.

Step 4:  Click on the "Apply" button located next to the deductible option you've chosen.

 

2. Or apply via mail by completing the enrollment application and standard health questionnaire (SHQ).  One SHQ is required for each family member.  Mail all items to Green Financial. Do not send any money with the application.  Once approved, you will be billed on a monthly basis.

Applications must be received in office prior to the end of the month to be considered
for an effective date for the first of the following month.

Enrollment Forms

Part 1
Enrollment Application - PDF Form (5 pages)

Part 2
Standard Health Questionnaire - PDF Form (23 pages)

Remember, one health questionnaire for each family member.  Although this form has 280 questions it is much easier to complete than it appears.  There are only 13 main sections (A through M). Answering "no" to any of the main questions allows you to skip the questions in that particular section.

If you prefer we can fax, mail, or e-mail these forms to you.  Either call us at 800-877-8019 or go to Home, Contact us and request. You'll need Acrobat Reader to display the PDF files.  If you don't have that program, you can download it free from Adobe.

Mail all forms to: Green Financial, P.O. Box 8036, Kirkland, WA 98034

Please call if any questions: 1-800-877-8019

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