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

Enter your Zip Code and Click on the "Get Quotes" link. This will take you through a paperless enrollment process.

Applications must be received complete by the 20th of the month to be considered for an effective date for the first of the following month. Applications received after the 20th will be considered for an effective date the 1st of the following month.

Enrollment Application (Part 1) (additional instructions for enrolling applicants under age 19)

Standard Health Questionnaire (242KB pdf, 23 pages) (Part 2)

No payment is required at this time.  You will be mailed a bill once you are approved for coverage.   

Automatic Transfer of Funds Form (optional)   If you prefer to have your premium payments transfer automatically from your checking or savings account then enclose this form with your application.

Important Note: The enrollment process requires an enrollment application and the Standard Health Questionnaire for each person applying for coverage. For example, a family of five would require one enrollment application and five Health Questionnaires. Refer to application checklist found on enrollment application for instructions.

The Health Questionnaire was designed by the Washington State Health Insurance Pool and is a standardized form required by all individual plans offering coverage in Washington State. This multi-page form is broken into several sections. Answering "No" to a given section allows you to move on to the next section making the form faster to complete than it appears.

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.

The linked documents are PDF files, and you'll need Acrobat Reader to display them. If you don't have that program, you can download it free from Adobe.