Membership Forms, Contracts, etc.

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Membership Forms, Benefit Forms, Voter Registration Forms

  March 1, 2010
New State of Washington/Individual Provider Contracts and Highlights (2009-2011) are now available for online ordering.

November 11, 2009
DSHS Case Managers: We have a new IP Health Insurance Enrollment Form availble for download and bulk orders. (See Document #9).

Agency Employers: Please continue to conact the Health Trust Office at 1 (866) 771-7359 to request forms specific to your agency/office.


To download any of these documents and print them out yourself, simply click on the title or image to open a printable PDF.

To order any of these documents in bulk, please go to our Online Order Form .


  thb-memform-english
#1 Membership form
 (English)

  thb-memform-korean
#2: Membership form  
(Korean)

  thb-memform-russian
#3 Membership form  
(Russian)  

thb-memform-spanish
#4 Membership form
(Spanish)

  IP Benefits Summary 
#5 IP Health/Vision
Benefits Summary
Dental Benefits Summary 
#6 Dental Benefits
Summary
IP Contract info
#7
    IP CBA Highlights (Summary) 2009-2011		   Washington Voter Registration Form
# 8 Washington State Voter Reg. form
(English; other languages available here )

IP Health Insurance Enrollment Form
# 9 DSHS Case Managers Only:
IP Health Insurance Enrollment Form





Contracts
To order bulk copies of contracts or contract highlights, or any of the other forms on this page, you can also use the Online Order Form .

If you are a member and would like a single copy of our contract with your facility or agency, please call our Member Resource Center toll-free at  1 (866) 371-3200.