WDIA Insurance Forms & Disclosure Information

Employee Enrollment and Waiver Forms

2024 Regence Enrollment Change Form
Regence Waiver Form
2024 KPWA Employee Enrollment Form
KPWA Waiver Form
2024 Premera Enrollment Form
Premera Waiver Form
2024 ASURIS Enrollment Change Form
Asuris Waiver Form
2024 Aetna Employee Enrollment & Waiver Form

Group Medical Compensation Disclosure Statements

In accordance with Section 202 of the Consolidated Appropriations Act of 2021, the following guides provide important information that you should consider in connection with the services provided by Washington Dentists’ Insurance Agency as the producer for your group medical coverage.

Please download the necessary guide for your records.

2022 Asuris NW Health Compensation Disclosure
2022 Kaiser Pemanente Compensation Disclosure
2022 Premera Blue Cross Compensation Disclosure
2022 Regence BlueShield Compensation Disclosure

Questions?

If you have any questions concerning this guide or the information provided to you concerning our services or compensation, please contact us.