Apply on Paper – Asuris Clarity 80^SM

Print and complete these forms:

• Application for Coverage (PDF) – Takes about 30 minutes.
• Health Questionnaire (PDF) – This may take a little longer. Fill out one for each person you are covering.

Send forms to:
Asuris Northwest Health
P.O. Box 13368
Spokane, WA 99213-3368

Or skip the paper and
NOTE: If you apply online now, you must complete the Standard Health Questionnaire on paper and mail it to us. We're currently working to get the questionnaire back online and will make it available as soon as possible. For an October 1 effective date, remember you just need to submit your application by September 20. Questions? 1 (866) 704-2708.

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