Plan Information

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

Kaiser Permanente Plan Information

Access PPO 200
2 files
pdf
Summary
201 kb
pdf
SBC
282 kb
Access PPO 500
2 files
pdf
Summary
201 kb
pdf
SBC
282 kb
Access PPO 1000
2 files
pdf
Summary
202 kb
pdf
SBC
282 kb
Access PPO 1500
2 files
pdf
Summary
201 kb
pdf
SBC
282 kb
Access PPO 2000
2 files
pdf
Summary
201 kb
pdf
SBC
282 kb
Access PPO 2500
2 files
pdf
Summary
205 kb
pdf
SBC
282 kb
Access PPO 3000
2 files
pdf
Summary
201 kb
pdf
SBC
282 kb
Access PPO 5000
2 files
pdf
Summary
252 kb
pdf
SBC
280 kb
Access PPO 6000
2 files
pdf
Summary
211 kb
pdf
SBC
280 kb
Access PPO 7500
2 files
pdf
Summary
212 kb
pdf
SBC
280 kb
Access PPO HSA 1750
2 files
pdf
Summary
265 kb
pdf
SBC
293 kb
Access PPO HSA 2500
2 files
pdf
Summary
236 kb
pdf
SBC
293 kb
Access PPO HSA 3500
2 files
pdf
Summary
280 kb
pdf
SBC
292 kb
Access PPO HSA 5500
2 files
pdf
Summary
214 kb
pdf
SBC
293 kb
HMO 250
2 files
pdf
Summary
176 kb
pdf
SBC
275 kb
HMO 500
2 files
pdf
Summary
177 kb
pdf
SBC
277 kb
HMO 750
2 files
pdf
Summary
176 kb
pdf
SBC
277 kb
HMO 1000
2 files
pdf
Summary
409 kb
pdf
SBC
277 kb
HMO 2000
2 files
pdf
Summary
177 kb
pdf
SBC
276 kb
HMO 3000
2 files
pdf
Summary
410 kb
pdf
SBC
277 kb
HMO 5000
2 files
pdf
Summary
412 kb
pdf
SBC
274 kb
HMO HSA 1750
2 files
pdf
Summary
439 kb
pdf
SBC
286 kb
Access Choice 2
2 files
pdf
Summary
202 kb
pdf
SBC
282 kb
Access Choice 3
2 files
pdf
Summary
202 kb
pdf
SBC
282 kb
Access Choice 5
2 files
pdf
Summary
202 kb
pdf
SBC
282 kb

Claims and Payment
3 files
pdf
Sample ID Cards
149 KB
Member Services
0 KB
Preventive Care
0 KB

Network and Provider
13 files
pdf
Care Pathways: Care When and Where you Need It
41.95 KB
Immediate Care Options
0 KB
Aetna Signature Administrators PPO Provider Search
0 KB
pdf
Access PPO Network Flyer
499.75 KB
pdf
Access PPO Travel Flyer
387 kb
pdf
Core Network Flyer
14.53 MB
pdf
Core Network Travel Flyer
938 kb
html
KPWA - Additional Networks
0 KB
Pharmacy Services
0 KB
pdf
HSA Drug List
421 kb
pdf
Optum Rx Network
0 KB
pdf
Prescription Transfer Form
0 KB
pdf
Rx Reimbursement Form
0 KB

Notices
2 files
Notice of Privacy Practices
0 KB
Kaiser Permanente Non Discrimination Notice and Language Access Services
0 KB

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

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

Premera Plan Information

WCIF 500
2 files
pdf
Summary
918 kb
pdf
SBC
598 kb
WCIF 750
2 files
pdf
Summary
712 kb
pdf
SBC
598 kb
WCIF 1250
2 files
pdf
Summary
711 kb
pdf
SBC
598 kb
WCIF 2000
2 files
pdf
Summary
711 kb
pdf
SBC
598 kb
WCIF 3000
2 files
pdf
Summary
711 kb
pdf
SBC
598 kb
WCIF 5000
2 files
pdf
Summary
713 kb
pdf
SBC
600 kb
WCIF HSA 1750
2 files
pdf
Summary
701 kb
pdf
SBC
596 kb
WCIF HSA 3000
2 files
pdf
Summary
700 kb
pdf
SBC
596 kb
Notices
2 files
Premera Notice of Privacy Practices
0 KB
pdf
Premera Blue Cross Non-discrimination Notice
0 KB
Claims & Payment
3 files
pdf
Sample ID Card
115.11 KB
pdf
Preventive Care
171 kb
pdf
Transition of Care
507.88 KB

WCIF 200
2 files
pdf
Summary
712 kb
pdf
SBC
598 kb
WCIF 6000
2 files
pdf
Summary
694 kb
pdf
SBC
621 kb
WCIF 7500
2 files
pdf
Summary
694 kb
pdf
SBC
621 kb
WCIF HSA 5000
2 files
pdf
Summary
700 kb
pdf
SBC
595 kb
WCIF Choice 2
2 files
pdf
Summary
710 kb
pdf
SBC
598 kb
WCIF Choice 3
2 files
pdf
SBC
598 kb
pdf
Summary
710 kb
WCIF Choice 5
2 files
pdf
SBC
598 kb
pdf
Summary
917 kb

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.

Claims & Payment
3 files
pdf
Sample ID Card
115.11 KB
pdf
Preventive Care
171 kb
pdf
Transition of Care
507.88 KB

Network and Provider
6 files
Find A Provider
0 KB
pdf
Virtual Care
89 kb
pdf
PV Core Drug List
167 kb
pdf
Rx Savings Solutions
1.03 MB
pdf
Kinwell Promo Package
4.83 MB
pdf
Blue365 Member Flyer
1.83 MB

Pharmacy
5 files
Find A Provider
0 KB
Mail Order Pharmacy
0 KB
Rx Search
0 KB
pdf
HSA PV Core Drug List
167 kb
pdf
Prescription Drug Reimbursement Form
0 KB
Medical transport protection from MASA

Delta Dental Plan Information

Plan C (00497)
1 file
pdf
Summary
259 kb
Plan D (00497)
1 file
pdf
Summary
267 kb
$3k PPO Plan
1 file
pdf
Summary
259 kb
Basic Plan
1 file
pdf
Summary
260 kb
Incentive (00501)
1 file
pdf
Summary
330 kb
Voluntary (00478)
1 file
pdf
Summary
260 kb
Incentive+ Plan
1 file
pdf
Summary
387 kb
Voluntary Low Plan
1 file
pdf
Summary
259 kb

Notices
2 files
pdf
Delta Dental of Washington Notice of Privacy Policy
218.15 KB
ashx?la=en
Delta Dental of Washington Non-discrimination Policy
0 KB

Willamette Dental Plan Information

High Plan
1 file
pdf
Summary
93 kb

Member Resources
3 files
html
Willamette Dental Notice of Non-discrimination Policy
0 KB
htm
FAQ
0 KB
pdf
Group Dental Implant Surgery Benefit
81.88 KB

Vision Service Plan (VSP) Information

Extended
1 file
pdf
Summary
484 kb
Standard
1 file
pdf
Summary
405 kb
Budget
1 file
pdf
Summary
413 kb
EasyOptions
1 file
pdf
Summary
1.3 mb
Voluntary
1 file
pdf
Summary
548 kb

Notices
2 files
Vision Service Plan Privacy Notice
0 KB
html
Vision Service Plan Non-discrimination Statement
0 KB

Call (800) 777-4114 for all WCIF members and their households. When calling, first identify yourself as part of WCIF and then your Employer Group for assistance. 

First Choice Health EAP Information

First Choice Health EAP
14 files
pdf
WCIF EAP Summary.pdf
249 kb
pdf
EAP Supporting Services
3.9 mb
pdf
Brochure
3.2 MB
pdf
Talkspace Overview
862.02 KB
pdf
Talkspace Member FAQ
1.7 mb
pdf
Juror EAP Program
1.2 mb
pdf
Financial Support
625 kb
pdf
Identity Theft Support
645 kb
pdf
Child Care
629 kb
pdf
Elder Care
533 kb
pdf
Home Ownership
269 kb
pdf
Legal Support
651 kb
pdf
Legal Support - Immigration
667 kb
jsp
First Choice Health EAP Privacy Policy
0 KB

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

The Standard Forms

All Lines Enrollment Form
3 files
pdf
All Lines Enrollment and Change Form
0 KB
pdf
Medical History Statement
0 KB
pdf
Disabled Dependant Form
0 KB

Basic & Voluntary Life Forms
10 files
pdf
Enrollment and Change Form
0 KB
pdf
Life Claim Packet
0 KB
pdf
Beneficiary Designation & Change Form
0 KB
pdf
Accelerated Benefit Employee Claim Form.pdf
0 KB
pdf
Accelerated Benefit Claim Form for Spouses / Dependents
0 KB
pdf
Waiver of Premium Claim Packet
0 KB
pdf
Group Life Portability Application
0 KB
pdf
Group Life Conversion Materials
0 KB
pdf
Evidence of Insurability Form (Medical History Statement)
0 KB
Evidence of Insurability Online Submission
0 KB

Voluntary Accidental Death and Dismemberment Forms
3 files
pdf
Enrollment and Change Form
0 KB
pdf
VAD&D Claim Packet
0 KB
pdf
VAD&D Booklet (Enrollment Form Attached)
0 KB

Long Term Disability Forms
5 files
pdf
Enrollment and Change Form
0 KB
pdf
LTD Claim Packet
0 KB
pdf
LTD Conversion Form
0 KB
pdf
Buy-Up LTD Booklet (enrollment form attached)
0 KB
pdf
Buy-Up LTD Enrollment Form
0 KB

Voluntary Short Term Disability Forms
2 files
pdf
Enrollment and Change Form
0 KB
pdf
STD Claim Packet
0 KB

The Standard Plan Information


Life Plans

Voluntary Accidental Death & Dismemberment (VAD&D)
1 file
pdf
Booklet
0 KB
Voluntary Term Life (VTL)
1 file
pdf
Booklet
0 KB
1x Annual Salary to $50,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
270.23 KB
1x Annual Salary to $150,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
323.39 KB
1x Annual Salary to $100,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
323.38 KB
1x Annual Salary to $200,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
270.25 KB
2x Annual Salary to $200,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
270.26 KB
$12,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
323.01 KB
$15,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
323.26 KB
$20,000
2 files
pdf
Benefit at a Glance
0 KB
pdf
Certificate
322.57 KB
$24,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
322.87 KB
$36,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
323.69 KB
$40,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
269.92 KB
$48,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
323.19 KB
$50,000
2 files
pdf
Benefits at a Glance
0 KB
pdf
Certificate
270.29 KB
$75,000
2 files
pdf
Benefit at a Glance
0 KB
pdf
Certificate
270.11 KB
$100,000
2 files
pdf
Certificate
270.27 KB
pdf
Benefit at a Glance
0 KB

Disability Plans

Guide to Taxation of Employee Disability Benefits
1 file
pdf
Guide to Taxation of Employee Disability Benefits
0 KB
Voluntary Short Term Disability (VSTD)
1 file
pdf
Booklet
0 KB
Base Long Term Disability (LTD)
1 file
pdf
Benefits at a Glance
0 KB
Voluntary Buy-Up Long Term Disability (LTD)
1 file
pdf
Booklet
0 KB
Employer Paid Long Term Disability (LTD)
4 files
pdf
Flyer - 90 Day
0 KB
pdf
Flyer - 180 Day
0 KB
pdf
Benefits at a Glance - 90 Day
0 KB
pdf
Benefits at a Glance - 180 Day
0 KB

Additional Documents
8 files
pdf
Plan Selection Card
0 KB
pdf
Accelerated Benefit Provision
0 KB
pdf
Portability & Conversion Overview
113.02 KB
pdf
Sample Portability Conversion Notice
98.33 KB
pdf
Travel Assistance Flyer
0 KB
pdf
Life Services Toolkit
0 KB
pdf
Minor Beneficiaries Payout Options
10.89 KB
pdf
Waiver of Premium FAQ
0 KB

Rehn & Associates (CDH) Forms

CDH Forms
9 files
pdf
HRA Enrollment Form
715.97 KB
pdf
FSA Enrollment Form
277.94 KB
pdf
LPFSA Enrollment Form
242.55 KB
pdf
HSA Enrollment Form
438.24 KB
pdf
Commuter Benefits Enrollment Form
723.88 KB
pdf
Reading the 5498-SA Health Savings Account (HSA) Tax Form
423.13 KB
pdf
Health Care Claim Form
230.48 KB
pdf
Dependent Care Claim Form
717.25 KB
pdf
Commuter Benefits Claim Form
473.65 KB

Rehn & Associates (CDH) Information

FSA
11 files
pdf
CDH FSA Account Overview
287.96 KB
pdf
CDH Advantages of the FSA
283.13 KB
pdf
Limited Purpose FSA (LPFSA) Overview
197.02 KB
pdf
2023 DFSA Handout (ER Specific)
269.21 KB
pdf
CDH Mobile App
269.84 KB
pdf
CDH Eligible Expenses (OTC)
303.96 KB
pdf
CDH FSA - Rollover FAQs
191.25 KB
pdf
CDH FSA - Grace Period FAQs
190.11 KB
pdf
CDH Prepaid Benefits Card FAQs
256.03 KB
pdf
Consumer Portal Quickstart Guide (Debit Card)
512.99 KB
pdf
Healthcare FSA Tax Savings Estimator
233.49 KB

HSA
4 files
pdf
5 Benefits of a HSA
158.35 KB
pdf
HSA Fact Sheet
270.46 KB
pdf
Consumer Portal Quickstart Guide (Debit Card)
512.99 KB
pdf
Reading the 5498-SA Health Savings Account (HSA) Tax Form
423.13 KB

HRA
4 files
pdf
CDH Prepaid Benefits Card FAQs
256.03 KB
pdf
CDH Mobile App
269.84 KB
pdf
Consumer Portal Quickstart Guide (Debit Card)
512.99 KB
pdf
Consumer Portal QuickStart Guide (No Debit Card)
432.47 KB

 

MetLife Forms

MetLife Forms
6 files
pdf
MetLife Legal Plan Enrollment Form
88.99 KB
pdf
MetLife Aura IF Protection Enrollment Form
113.23 KB
pdf
MetLife A-CI-H Combined Enrollment Form
404.76 KB
doc
Critical Illness Enrollment Form
153 KB
doc
Hospital Indemnity Enrollment Form
117 KB
doc
Accident Enrollment Form
113 KB

MetLife Plan Information

MetLife Plan Information
4 files
pdf
MetLife Combined Product Packet
7.9 mb
pdf
MyBenefits Flyer
773.09 KB
pdf
Instructions for WCIF MyBenefits Portal
1.12 MB
MetLife Privacy Policy
0 KB
Legal Plan
2 files
pdf
Legal Plan Enrollment Form
112 kb
pdf
Legal Plan Summary
985 kb
Aura ID Theft & Fraud Prevention Plan
2 files
pdf
Aura ID Theft & Fraud Prevention Plan Summary
1.1 mb
pdf
Aura ID Theft & Fraud Prevention Plan Enrollment Form
95 kb
Pet Insurance
3 files
pdf
Pet Insurance FAQ
388 kb
pdf
Sample Pet Insurance Policy
2 MB
pdf
Metlife Exotic Pet Care
1.6 mb

Critical Illness Insurance
3 files
pdf
Overview
154.2 KB
pdf
Summary
998 kb
pdf
FAQ
124.99 KB

Hospital Indemnity Insurance
3 files
pdf
Overview
222.21 KB
pdf
Summary
1.1 mb
pdf
FAQ
113.37 KB

Accident Insurance
3 files
pdf
FAQ
75.37 KB
pdf
Overview
135.15 KB
pdf
Summary
1.1 mb