• Service Plans
• Frequently Asked Questions
• Enrollment

Eligibility

Coverage for individuals and families is available statewide to permanent Washington State residents, except those eligible for Medicare.  Eligible family members include you, your spouse, and unmarried children under age 25 who are primarily dependent on you for support.

Enrollment Forms & Instructions

Completed enrollment materials must received in our office on the last business day of the month will be effective on the first of the following month (e.g. July 31st for August 1st effective date).  Applications received on or before 14th of the month (or last business day prior to the 14th if it falls on a weekend) will be effective on the 15th of that month (e.g. July 15th for July 15th effective date).

1. Complete the LifeWise Health Plan of Washington Enrollment Application.  Only one application is necessary per family.
2. Complete the Standard Health Questionnaire.  A separate questionnaire must be completed for each enrolling family member unless:
   • Relocation: Applicant is applying within 90 days of having relocated within Washington State and the prior health plan is not available.  Include a copy of a utility bill in your name from the prior address and a letter of verification from your prior carrier.
   • Provider Cancellation:  Applicant’s health care provider left prior plan’s network therefore applicant is applying within in 90 days to a carrier that the provider is participating.  Include a letter of verification from the provider or carrier. 
   • COBRA Exhaustion:  The applicant has exhausted all COBRA continuation coverage and is applying within 90 days of COBRA ending or you lost coverage due to your employer going out of business or disontinuing its health plan while you were on COBRA.  Include a letter from the COBRA Administrator verifying that you have exhausted your COBRA benefits. 
   • Employer’s Plan Not Subject to COBRA: Applicant is applying within 90 days of losing coverage under an employer’s plan that was not subject to COBRA coverage and you had at least 24 months of continuous group coverage before such loss.  Include a letter of verification from the employer.
   • COBRA Early Termination – Applicant applying within 90 days of terminating your COBRA coverage and you had at least 24 months of continuous group coverage prior to termination. Include a letter of verification from your employer addressing your termination of COBRA and a certificate of coverage for proof of 24 months of continuous group coverage.
   • COBRA Eligible – Applicant is applying within 90 days of an event which qualifies you for COBRA and you had at least 24 months of continuous group coverage prior to such event buy you chose not to take COBRA coverage. Include a letter of verification from your employer addressing your COBRA eligibility and a certificate of coverage for proof of 24 months of continuous coverage. 
   • Loss of Basic Health Plan (BHP) Coverage:   Applicant is applying within 90 days of losing coverage under the BHP and had at least 24 months of continuous BHP coverage before such loss.  Include a letter of verification from the BHP. 
   • Addition of Newborn: Applicant is adding a newborn or newly adopted child to an existing policy within 60 days of birth, adoption or date of placement for adoption.  Include copy of birth certificate/adoption papers. 
   
    
3. Submit your Enrollment Application and Standard Health Questionnaire to:
   
   
   R. L. Evans Company, Inc.
   3535 Factoria Blvd SE, Ste 120
   Bellevue, WA  98006