Get Regence Domestic Partner Form

Filling out the Regence Domestic Partner Form online allows you to enroll your domestic partner in health benefit plans with ease. This guide provides clear instructions on each section of the form, ensuring that users can complete it accurately and effectively.

Follow the steps to complete the Regence Domestic Partner Form online

1. Click ‘Get Form’ button to access the form and open it for completion.
2. Begin with Section I, where you will need to provide your name as the policyholder, your ID number, and the date your domestic partnership began. Ensure the date is formatted as mm/dd/yyyy.
3. Enter your domestic partner's name in the designated field. Under the criteria section, confirm that you and your partner meet all requirements for a domestic partnership by checking the boxes provided.
4. Proceed to Section II, where you must agree to notify Regence BlueShield of Idaho within 30 days of any changes to your domestic partnership status. Fill in the name of the contract holder.
5. In Section III, acknowledge that the information provided will remain confidential and understand the implications of your declarations. This section requires the signatures of both the policyholder and the domestic partner, along with the corresponding dates.
6. Once all sections are completed, review the form for accuracy. You may choose to save your changes, download the completed form, print it, or share it as needed.

Complete your Regence Domestic Partner Form online today to ensure your partner receives the necessary health benefits.