Get the free regence form 5201wa

An AB CDE Health Group Number Employee Last Name Subgroup Class Group Name First Name Regency Bluesier 1800 Ninth Avenue Seattle, WA 98101 Mail form to: PO Box 1200 Portland, OR 97207-1200 Fax to:

How to fill out regence form 5201wa

How to fill out regence form 5201wa:

1. Start by providing your personal information such as your name, address, date of birth, and social security number.
2. Next, indicate whether you are the primary policyholder or a dependent on someone else's insurance plan.
3. Provide details about your insurance coverage, including the policy number and group number, if applicable.
4. Fill out the section related to the patient's information, including their name, date of birth, and relationship to the policyholder.
5. Specify the reason for filling out the form, whether it is a new enrollment, a change in coverage, or a request for reimbursement.
6. Complete the section regarding the services or treatment for which you are seeking coverage or reimbursement.
7. If applicable, include any supporting documentation required to process the form, such as medical bills or receipts.
8. Review the completed form for accuracy and ensure all required fields are filled out.
9. Sign and date the form before submitting it to the appropriate insurance provider.

Who needs regence form 5201wa:

1. Individuals who are covered by Regence or its affiliated insurance plans may need to fill out Form 5201wa.
2. This form is often required for new enrollees seeking to establish coverage or make changes to their existing policy.
3. Additionally, individuals who have received medical services and are seeking reimbursement from Regence may also need to complete this form.

For pdfFiller’s FAQs

How can I modify regence form 5201wa without leaving Google Drive?

People who need to keep track of documents and fill out forms quickly can connect PDF Filler to their Google Docs account. This means that they can make, edit, and sign documents right from their Google Drive. Make your regence form 5201wa into a fillable form that you can manage and sign from any internet-connected device with this add-on.

How can I send regence form 5201wa to be eSigned by others?

When you're ready to share your regence form 5201wa, you can swiftly email it to others and receive the eSigned document back. You may send your PDF through email, fax, text message, or USPS mail, or you can notarize it online. All of this may be done without ever leaving your account.

How do I make changes in regence form 5201wa?

With pdfFiller, you may not only alter the content but also rearrange the pages. Upload your regence form 5201wa and modify it with a few clicks. The editor lets you add photos, sticky notes, text boxes, and more to PDFs.

What is regence form 5201wa?

Regence form 5201wa is a specific form required by Regence BlueShield, a health insurance company in Washington state. It is used to report certain health insurance information.

Who is required to file regence form 5201wa?

Certain employers who provide health insurance coverage to their employees in Washington state are required to file regence form 5201wa. The exact criteria for filing may vary, so it is recommended to refer to the instructions provided by Regence BlueShield.

How to fill out regence form 5201wa?

To fill out regence form 5201wa, you will need to gather the necessary information about your health insurance coverage and the employees you provide coverage to. Then, follow the instructions provided by Regence BlueShield to accurately complete the form. It is recommended to review the form instructions and seek professional assistance if needed.

What is the purpose of regence form 5201wa?

The purpose of regence form 5201wa is to collect information about the health insurance coverage provided by employers in Washington state. This information is used by Regence BlueShield and relevant authorities to ensure compliance with applicable health insurance regulations and to assess the availability and affordability of health insurance coverage.

What information must be reported on regence form 5201wa?

Regence form 5201wa requires the reporting of various information related to health insurance coverage. This may include the employer's name and contact information, the number of employees covered, the total monthly premiums, and other details specific to the employer's health insurance plan. The exact information to be reported can be found in the form instructions provided by Regence BlueShield.