Employees

Find A Provider

WCIF contracts with the top carriers in the state for our employee benefit plans.
Please click on the carrier logos below for access to provider directories.

*For Premera plans, select “Heritage” or “Prime” Network – Includes Pharmacy

*For Kaiser Permanente plans, select “Access PPO” or “Core” Network – Includes Pharmacy

If you can’t find what you’re looking for, please contact WCIF for assistance.

The Standard plan administration is handled by WCIF. Please contact WCIF with questions regarding your coverage.

(800) 777-4114 for all WCIF members and their households

(855) 623-6334 or cobra@vimly.com for COBRA and Retirees Administration or (206) 859-2694 or wcif@vimly.com

Plan Forms, Materials and Notifications for Administrators

Below you will find WCIF plan forms and materials separated by carrier.  Most forms are available under the Employees Tab; however this page also offers additional forms, notifications and information that are for administrative use only. If you need copies mailed to you or cannot find what you are looking for, please contact Shawna Zusi-Cobb at shawna@wcif.net.

Demographic Change Form
Group Benefit Enrollment & Change Form | Non-Medical
Group Benefit Enrollment & Change Form | All Lines

    HIPAA Forms

    HIPAA Forms
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    HIPAA Authorization for Release of Personal Health Information (PHI)Download
    Waiver of Medical CoverageDownload

      Domestic Partnership Forms

      Domestic Partnership Forms
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      Declaration of Termination of Domestic PartnershipDownload
      Affidavit of Domestic PartnershipDownload

        COBRA

        COBRA
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        Sample COBRA General Notice Download
        COBRA Notice to an Employer of a Qualifying EventDownload
        Sample HRA FSA COBRA General NoticeDownload
        Notice to Vimly of Employee's or Dependent's Qualification for COBRADownload

          Carrier Forms

          CDHP Forms
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          HRA Enrollment FormDownload
          FSA Enrollment FormDownload
          HSA Enrollment FormDownload
          HSA Transfer Request FormDownload
          Reading the 5498-SA Health Savings Account (HSA) Tax FormDownload
          Health Care Claim FormDownload
          Dependent Care Claim FormDownload
          Commuter Benefits Claim FormDownload
          No Package Found!
          No Package Found!
          No Package Found!
          MetLife Forms
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          All Lines Enrollment FormDownload
          Critical Illness Enrollment FormDownload
          Hospital Indemnity Enrollment FormDownload
          Accident Enrollment FormDownload
          All Lines Enrollment Form
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          All Lines Enrollment FormDownload
          Basic & Voluntary Life Forms
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          Life Claim PacketDownload
          Beneficiary Designation & Change FormDownload
          Basic & Voluntary Life FormsDownload
          Accelerated Benefit Employee Claim Form.pdfDownload
          Accelerated Benefit Claim Form for Spouses / DependentsDownload
          Waiver of Premium Claim PacketDownload
          VTL Booklet (enrollment form attached)Download
          Group Life Portability ApplicationDownload
          Group Life Conversion MaterialsDownload
          Evidence of Insurability Form (Medical History Statement)Download
          Evidence of Insurability Online Submission Download
          Voluntary Accidental Death and Dismemberment Forms
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          VAD&D Claim PacketDownload
          VAD&D Booklet (Enrollment Form Attached)Download
          Long Term Disability Forms
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          2016 LTD Claim PacketDownload
          LTD Conversion FormDownload
          Buy-Up LTD Booklet (enrollment form attached)Download
          Buy-Up LTD Enrollment FormDownload
          Voluntary Short Term Disability Forms
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          VSTD Booklet (enrollment form attached)Download
          VSTD Claim PacketDownload

          2024 Plan Information

          2024 Plan Information

          Notices
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          Premera Notice of Privacy PracticesDownload
          Premera Blue Cross Non-discrimination NoticeDownload
          WCIF 200
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          SummaryDownload
          SBCDownload
          WCIF 500
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          SBCDownload
          WCIF 750
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          SummaryDownload
          SBCDownload
          WCIF 1250
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          SummaryDownload
          SBCDownload
          WCIF 2000
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          SummaryDownload
          SBCDownload
          WCIF 3000
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          SummaryDownload
          SBCDownload
          WCIF 5000
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          SummaryDownload
          SBCDownload
          WCIF HSA 1600
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          SummaryDownload
          SBCDownload
          WCIF HSA 3000
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          SummaryDownload
          SBCDownload
          WCIF HSA 5000
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          SummaryDownload
          SBCDownload
          WCIF Choice 2
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          SummaryDownload
          SBCDownload
          WCIF Choice 3
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          SummaryDownload
          SBCDownload
          WCIF Choice 5
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          SummaryDownload
          SBCDownload

          WCIF Premera medical plans have two separate networks, Heritage Plus and Prime.

          When choosing a provider, it is important the provider is in the member’s network.  Premera member ID cards will identify which network applies.  If unsure, please contact customer service at Premera.

          Member Resources

          Claims & Payment
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          Sample ID CardDownload
          Preventive CareDownload
          Transition of CareDownload
          Network and Provider
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          Find A ProviderDownload
          Virtual CareDownload
          Pharmacy
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          Find A ProviderDownload
          Mail Order PharmacyDownload
          Rx SearchDownload
          HSA PV Core Drug ListDownload
          Prescription Drug Reimbursement FormDownload

          2024 Plan Information

          Access PPO HSA 2500
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          SummaryDownload
          Access PPO HSA 5500
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          SummaryDownload
          Access PPO 2500
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          SummaryDownload
          Access PPO 1500
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          SummaryDownload
          Access Choice 5
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          SummaryDownload
          Access Choice 3
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          SummaryDownload
          Access Choice 2
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          SummaryDownload
          Access PPO 200
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          SummaryDownload
          Access PPO 500
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          SummaryDownload
          Access PPO 1000
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          SummaryDownload
          Access PPO 2000
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          SummaryDownload
          Access PPO 3000
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          SummaryDownload
          Access PPO 5000
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          SummaryDownload
          Access PPO HSA 1600
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          SummaryDownload
          Access PPO HSA 3500
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          SummaryDownload
          HMO 250
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          SummaryDownload
          HMO 500
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          SummaryDownload
          HMO 750
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          SummaryDownload
          HMO 2000
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          SummaryDownload

          Member Resources

          Claims and Payment
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          Sample ID Cards - Core HMODownload
          Sample ID Card - Access PPODownload
          Member ServicesDownload
          Preventive CareDownload
          Network and Provider
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          Find A ProviderDownload
          Virtual Care (CareNow)Download
          First Choice Health Network (Washington, Alaska, Idaho, Montana, Oregon)Download
          First Health Network (National)Download
          Pharmacy ServicesDownload
          Prescription Transfer FormDownload
          Rx Reimbursement FormDownload
          Additional Resources
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          Kaiser Permanente Terms of Use and Privacy PolicyDownload
          Kaiser Permanente Non Discrimination Notice and Language Access ServicesDownload
          Healthy Discounts and ExtrasDownload

          Plan Information

          Basic Plan
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          SummaryDownload
          Voluntary (00478)
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          SummaryDownload
          Incentive (00501)
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          SummaryDownload
          Plan A (00498)
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          SummaryDownload
          Plan B (00498)
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          SummaryDownload
          Plan C (00497)
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          SummaryDownload
          Plan D (00497)
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          SummaryDownload
          Member Resources
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          Delta Dental of Washington Non-discrimination PolicyDownload
          Delta Dental of Washington Notice of Privacy PolicyDownload
          Find A ProviderDownload
          MySmile - Personal Benefits CenterDownload
          FAQDownload

          Plan Information

          High Plan
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          SummaryDownload
          Member Resources
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          Willamette Dental Notice of Non-discrimination PolicyDownload
          FAQDownload
          Find A ProviderDownload
          Group Dental Implant Surgery BenefitDownload

          Plan Information

          EasyOptions
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          SummaryDownload
          FlierDownload
          Voluntary
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          SummaryDownload
          CertificateDownload
          Extended
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          SummaryDownload
          CertificateDownload
          Standard
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          SummaryDownload
          CertificateDownload
          Budget
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          SummaryDownload
          CertificateDownload
          Member Resources
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          Vision Service Plan Privacy NoticeDownload
          Vision Service Plan Non-discrimination StatementDownload
          TruHearing Discount ProgramDownload
          Special OffersDownload
          When You Are Double Covered – Coordination of Benefits InformationDownload

          Life Plans

          Voluntary Accidental Death & Dismemberment (VAD&D)
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          BookletDownload
          CertificateDownload
          Voluntary Term Life (VTL)
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          BookletDownload
          1x Annual Salary to $50,000
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          Benefit at a GlanceDownload
          CertificateDownload
          1x Annual Salary to $150,000
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          Benefit at a GlanceDownload
          CertificateDownload
          1x Annual Salary to $100,000
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          Benefit at a GlanceDownload
          CertificateDownload
          2x Annual Salary to $200,000
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          Benefits at a GlanceDownload
          CertificateDownload
          $12,000
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          Benefit at a GlanceDownload
          CertificateDownload
          $15,000
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          Benefit at a GlanceDownload
          CertificateDownload
          $20,000
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          Benefit at a GlanceDownload
          CertificateDownload
          $24,000
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          Benefit at a GlanceDownload
          CertificateDownload
          $36,000
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          Benefit at a GlanceDownload
          CertificateDownload
          $40,000
          FileAction
          Benefit at a GlanceDownload
          CertificateDownload
          $48,000
          FileAction
          Benefit at a GlanceDownload
          CertificateDownload
          $50,000
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          Benefit at a GlanceDownload
          CertificateDownload
          $100,000
          FileAction
          Benefit at a GlanceDownload
          CertificateDownload

          Disability Plans

          Guide to Taxation of Employee Disability Benefits
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          Guide to Taxation of Employee Disability BenefitsDownload
          Voluntary Short Term Disability (VSTD)
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          BookletDownload
          Certificate - w/ Buy-Up LTDDownload
          Certificate - w/ Base LTDDownload
          Voluntary Buy-Up Long Term Disability (LTD)
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          BookletDownload
          CertificateDownload
          Base Long Term Disability (LTD)
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          Benefits at a GlanceDownload
          CertificateDownload
          Member Resources
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          Portability & Conversion OverviewDownload
          Travel Assistance FlyerDownload
          Life Services ToolkitDownload
          Minor Beneficiaries Payout OptionsDownload
          Waiver of Premium FAQDownload
          Critical Illness Insurance
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          SummaryDownload
          OverviewDownload
          FAQDownload
          Certificate (Low Plan)Download
          Certificate (High Plan)Download
          Informational VideoDownload
          Hospital Indemnity Insurance
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          SummaryDownload
          OverviewDownload
          FAQDownload
          Certificate (Low Plan)Download
          Certificate (High Plan)Download
          Informational VideoDownload
          Accident Insurance
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          FAQDownload
          OverviewDownload
          SummaryDownload
          Certificate (Low Plan)Download
          Certificate (High Plan)Download
          Informational VideoDownload
          FSA
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          CDH FSA Account OverviewDownload
          CDH Advantages of the FSADownload
          2023 DFSA Handout (ER Specific)Download
          CDH Mobile AppDownload
          CDH Eligible Expenses (OTC)Download
          Healthcare FSA Tax Savings EstimatorDownload
          CDH FSA - Rollover FAQs Download
          CDH FSA - Grace Period FAQsDownload
          CDH Prepaid Benefits Card FAQsDownload
          Consumer Portal QuickStart Guide (Debit Card)Download
          HSA
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          5 Benefits of a HSADownload
          HSA - FAQ Download
          HSA - Fact SheetDownload
          HSA Consumer Portal Quickstart GuideDownload
          Reading the 5498-SA Health Savings Account (HSA) Tax Form Download
          HRA
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          CDH Prepaid Benefits Card FAQsDownload
          CDH Mobile AppDownload
          Consumer Portal QuickStart Guide (Debit Card)Download
          Consumer Portal QuickStart Guide (No Debit Card)Download
          First Choice Health EAP
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          EAP Program SummaryDownload
          EAP Member FAQDownload
          Home OwnershipDownload
          EldercareDownload
          Childcare and EducationDownload
          24/7 Telehealth FlyerDownload
          Betterhelp Use GuideDownload
          Betterhelp Online FAQDownload
          First Choice Health EAP Privacy PolicyDownload
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          WCIF DISCOUNTS AND REWARDS

          Customer Care: 866-664-4621 or email them at customercare@benefithub.com

          WCIF Discounts & Rewards are partnered with BenefitHub to provide a FREE online portal available to all participating WCIF members. Select from thousands of local and nationwide discounts, hundreds of tools, wellness solutions, financial benefits, and many more!

          For questions regarding BenefitHub offerings, please contact BenefitHub directly.

          See your Human Resources OR contact WCIF directly for the referral code for site access at: 1-800-344-8570.