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    Welcome to WCIF!

    Who We Are

    Benefits are what we do BEST! WCIF is a public sector, nonprofit, multiple-employer health and welfare trust, serving all of Washington State.

    Employees

    Find plan summaries, enrollment forms, benefits information, carrier contacts, notices & more.

    Retirees

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    Information for employer groups and administrators: find admin guides, plan summaries, enrollment forms, benefits information, carrier contacts, notices & more.

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    Board of Trustees Manual, meeting documents & minutes.

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2024 GROUP MASTER APPLICATION

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This is an application for:(Required)

GROUP INFORMATION

Do you have subgroups with different benefits?(Required)
What name do you prefer WCIF use to refer to your organization?
Business Physical Address (No PO Box or PMB)(Required)
Business Mailing Address (if different from physical)
Is your organization a public entity?(Required)
What type of entity is your organization?(Required)

Is your entity or non-profit organization subject to ERISA?(Required)

Group Contact Information

Name & Title
Name & Title
Should this person have SIMON admin access?
Name & Title
Should this person have SIMON admin access?
Name & Title
Should this person have SIMON admin access?

Insurance Producer

Does your organization use an insurance producer for WCIF plans?
Producer Physical Address (No PO Box or PMB)
PRODUCER MUST RETURN SIGNED PRODUCER COMMISSION RATE SHEET(S) TO WCIF

DEFINITIONS & ELIGIBILITY

DEFINITIONS


WCIF Class Definition
Group of employees (affiliates, subsidiaries, or office locations within the same employer) with the same benefit options as the main group. Classes have the same Account Number as the main group, and are included on the same bill, but are assigned class codes and will have separate class premium totals on the bill.


WCIF Eligible Employees Definition
WCIF requires that employees work a minimum of 20 hours per week or 80 hours per month (whichever is less) to be eligible for benefits. An Employer may require an employee to work more than 20 hours per week or 80 hours per month based on employer policy or contractual requirements, and WCIF will honor the organization's minimum threshold. (Note: A covered employee will remain covered during any unpaid furlough so long as the covered employee does not exceed 30 unpaid furlough days in a single calendar year. Furlough days DO NOT include FMLA and PFML qualified absences, whether paid or unpaid). Elected officials of participating employers are eligible for coverage and are exempt from the minimum hour requirement.


WCIF Effective Date Definition
WCIF defines an employee's coverage effective date as follows. Employees hired:
● On the first of the month are eligible for coverage effective the date of hire. (If the first of the month falls on a weekend or holiday and the employee reports for work on the first business day following, coverage is retroactive to the first.)
● On the 2nd to the 31st of the month are eligible for coverage effective on the first day of the month following the date of hire.
Employers may impose their own waiting periods. If an employer chooses to do so, the effective dates as listed above will apply after the employee completes the employer's waiting period and becomes eligible for benefits. Note: Special eligibility provisions are in place for firefighters.


WCIF Eligible Dependent Definition
Dependents who are eligible for WCIF coverage include:
● A lawful spouse or domestic partner (Washington State Registered Domestic Partners are treated the same as a spouse),
● Children to age 26 including biological, step, foster, adopted children from the date of assumption of legal obligation for total or partial support, children required by court order or qualified medical child support order (QMCSO) to be covered by a participant.
Please Note: Dependent children are eligible for coverage to age 26 regardless of marital status, student status, or eligibility for coverage under another plan.
All other dependents are not eligible without evidence of legal guardianship.

ELIGIBILITY (This section is REQUIRED)

NOTE: A current census must accompany each new class designation. If you have a new class, please send current census to your Account Executive via email.
CLASS 1:
Eligibility: Minimum hours
Effective Date

Employer Contribution:
CLASS 2:
Eligibility: Minimum hours
Effective Date

Employer Contribution:

WEB ENROLLMENT & BILLING INFORMATION

Will the group process enrollment and billing via the Vimly online enrollment system?
Will the group add the Employee Self Service (ESS) module?
Will the group require separate classes to be broken out on bill?
If YES, for access to the online enrollment system and billing services, indicate the individual(s) authorized for online enrollment system updates. An email invitation will be sent out to the designated individual(s) to register for online enrollment system functionality. Note: If access for an additional user is desired, please contact Vimly for request form.
Does your organization offer non-WCIF medical plans to employees?
Other Medical Carrier(s)

Benefits Information

Plan information can be found at wcif.net/employees

Medical Plans

Directions: Designate 4-tiered rates or composite rates (subject to carrier approval). Note: All medical plans are bundled with a base long term disability plan and an employee assistance program (EAP).
Premera Blue Cross
Check to DECLINE Premera coverage:
Select Rate Structure(Required)
Select Network Option(Required)
Select Plan Choice(s)
The number of plans available to an organization is based on the group's total number of eligible employees. Employer groups may offer plan choices as allowed under the Premera matrix.
Kaiser Permanente
Check to DECLINE Kaiser Permanente coverage:
Select Rate Structure(Required)
Select Plan Choice(s): Kaiser Foundation Health Plan of WA, Options Inc. Access PPO Plans
The number of plans available to an organization is based on the group's total number of eligible employees. Employer groups may offer plan choices as allowed under the Kaiser Permanente matrix.
Select Plan Choice(s): Kaiser Foundation Health Plan of WA Core (HMO) Plans

Dental Plans

WCIF employer-paid dental plans require 100% employee participation. If elected, all eligible employees must be covered.
Delta Dental of Washington
Check to DECLINE Delta Dental coverage:
Plan A: $1,000 Annual Maximum PPO Plan
Plan B: $2,000 Annual Maximum PPO Plan
A-1 (100% Employer Paid)
B-4 (100% Employer Paid EXCEPT Dependents)
Plan C: $1,000 Annual Maximum Enhanced Plan
Plan D: $2,000 Annual Maximum Enhanced Plan
C-1 (100% Employer Paid)
D-3 (100% Employer Paid)
C-2 (100% Employer Paid EXCEPT Dependents)
D-4 (100% Employer Paid EXCEPT Dependents)
Incentive Plan: $2,000 Annual Maximum Plan
Basic Plan: $1,000 Annual Maximum PPO Plan
A-1 (100% Employer Paid)
(100% Employer Paid)
Voluntary or Other Plan

(100% Employer Paid EXCEPT Dependents)
Willamette Dental of Washington, Inc.
Check to DECLINE Willamette Dental coverage:
Employer Paid Plan
Voluntary Plan

Vision Plans

WCIF employer-paid vision plans require 100% employee participation. If elected, all eligible employees must be covered. Employer may offer more than one plan.
VSP Vision Care, Inc.
Check to DECLINE VSP coverage:
Extended Plan
Standard Plan
Budget Plan
Easyoptions Plan
Voluntary Plan

Group Life Plans / Accidental Death & Dismemberment Plans

Employers are required to enroll all benefit-eligible employees. Basic Life is 100% employer paid.
Standard Insurance Company
Basic Life Plans
$1,000 Basic Life Dependent Benefit (100% participation, employer paid)
Voluntary Plans
Group Disability Plans
Base LTD may be purchased for benefit eligible employees not enrolled in WCIF medical plans by checking the applicable box below. If elected, this is an employer paid benefit that requires 100% employee participation. Must have Base LTD in place to offer Voluntary Buy-Up LTD.
Disability options
Disability Bundled

Employee Assistance Program (EAP)

EAP may be purchased for employees not enrolled in WCIF medical plans by checking the applicable box below. If elected, this is an employer paid benefit that requires 100% employee participation. This plan features a special "Stand-Alone" option for employees who are not otherwise benefit eligible.
First Choice Health EAP
EAP options
EAP Coverage
When Stand-Alone Coverage is offered to otherwise non benefit-eligible employees, do you want these employees included in the monthly combined bill?(Required)

Worksite Products

Worksite products may be purchased by employees through payroll deduction.
Metropolitan Life Insurance Company
Check to DECLINE MetLife coverage:
MetLife Products

Consumer Driven Health Plans (CDH)

Rehn & Associates
Check to DECLINE CDH coverage:
Flexible Spending Arrangement (FSA)
Other
IMPORTANT NOTE: If you are not the person who will be signing this document, please click to the next screen, do not fill out the fields but scroll to the bottom and click SUBMIT. Once you click SUBMIT, you will be emailed a copy of your filled out form to sign and complete. Please submit all signed forms to renewals@wcif.net.

Acknowledgements & Disclosures

IMPORTANT NOTE: If you are not the person who will be signing this document, please do not fill out the signature field. Scroll to the bottom and click SUBMIT. Once you click SUBMIT, you will be emailed a copy of your filled out form to sign and complete. Please submit all signed forms to renewals@wcif.net.
Initials
Employer agrees to abide by the provisions of the Washington Counties Insurance Fund (WCIF) Trust Agreement and Bylaws.
Initials
Extent of Coverage
Employee benefits will end on the last day of the month in which the employee becomes ineligible (except as specified under federal and/or Washington state mandated extension rights). Employers may not continue an employee's coverage on any active plan after the employee is no longer eligible. The only exception to this rule is for employees who lose coverage due to a disability and need to continue life and disability plan coverage in order to apply for Waiver of Premium at a later date. Continuation of coverage through COBRA and retiree plans (for retirees under the age of 65) is available to employees who qualify; provided the employer maintains participation in a WCIF medical, dental, vision, EAP, and/or CDH plan(s).
Continuation of coverage is available in accordance with federal and Washington state law to members who become ineligible for group coverage. Employers have a legal responsibility for certain notification requirements. Please reference the WCIF eACE Manual (www.wcif.net) for notification procedures and forms for WCIF plans. Employers may also reference the US Department of Labor (www.dol.gov) and the US Internal Revenue Service (www.irs.gov) for further guidance. Advisory assistance on compliance with federal and state employment law regulations should be obtained from an employment attorney.
Initials
Medical Participation
Employers who offer WCIF medical coverage are required to cover a minimum of 75% of all eligible employees after excluding those waiving due to other qualifying coverage.

NOTE: For current groups who do not submit the Master Application by December 1, group benefits will default to their prior year elections, if available, or mapped to most comparable plan.
Initials
Waiver of Medical Insurance (for groups offering WCIF medical coverage)
Employer acknowledges that employees with other verifiable group medical coverage (i.e., another employer plan, Medicare, TriCare, VA (with ACA letter), Washington Healthplanfinder) are considered eligible participation exclusions, and do not count against the medical participation requirement. Employees with individual medical coverage outside Washington Healthplanfinder are not considered eligible participation exclusions and will count against a group's medical participation requirement.
Initials
Employer acknowledges that in order to allow an employee to waive WCIF medical coverage the employee must provide the employer with proof of other group medical insurance coverage.
Initials
Employer acknowledges that they may not offer cash incentives to employees who waive WCIF medical coverage.
Initials
Employers are required to offer the same coverage to their over age 65 employees (and over age 65 spouses/domestic partners) as they do to all other eligible employees. Employer coverage is primary to Medicare. Medicare beneficiaries are free to waive employer plan coverage, in which case they retain Medicare as their primary coverage. When Medicare is primary payer, employers cannot offer such employees (or their spouses) secondary coverage (or incentives) for items and services covered by Medicare.
PLEASE NOTE: If you are not the person who will be signing this document, please click SUBMIT now. You will be emailed a filled PDF form, which can then be emailed to the signer, or printed and signed. Please send final signed applications to renewals@wcif.net.

Signature

The below signed applicant agrees that if the requested insurance is acceptable to WCIF under its current rules and practices and is legally permissible, a policy will be issued in the policy language customarily used by WCIF and will be effective on the date determined by WCIF.
The below signed applicant acknowledges it is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.
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NOTE: You can also sign this document by clicking Submit

Carrier Information

Premera Blue Cross
7001 220th St SW
Mountlake Terrace, WA 98043
Plan number unique to employer.
Contact WCIF at (800) 344-8570 to obtain.
Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association.

Kaiser Foundation Health Plan of WA Options, Inc.
1300 SW 27th St
Renton, WA 98057
Plan number unique to employer.
Contact WCIF at (800) 344-8570 to obtain.

Kaiser Foundation Health Plan of WA
1300 SW 27th St
Renton, WA 98057
Plan number unique to employer.
Contact WCIF at (800) 344-8570 to obtain.

Delta Dental of Washington
400 Fairview Avenue N, Suite 800
Seattle, WA 98109
Plan Numbers: 00497 00498 00500 09519 00501 00502 00478
Willamette Dental of Washington, Inc.
6950 NE Campus Way
Hillsboro, OR 97124
Plan Number: WA204

Standard Insurance Company
1100 SW 6th Avenue
Portland, OR 97204
Plan Number: 645273

VSP Vision Care, Inc.
3333 Quality Drive Rancho
Cordova, CA 95670
Plan Number: 30029829

First Choice Health EAP
600 University Street Suite 1400
Seattle, WA 98101

Metropolitan Life Insurance Company
200 Park Avenue
New York, NY 10166
Plan number unique to member.

Rehn & Associates
1322 N. Post Pl.
Spokane, WA 99201
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