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Order Supplies
Asuris Northwest Health Individual Marketing Supplies Order Form
Click on image to enlarge

Please allow seven (7) business days for delivery. If you have not received your order in this time frame, please contact your Sales Representative for assistance. Please do not re-enter your order as this could result in additional delays. Thank you.
Quantity
Click on image to enlarge. Asuris Individual Sales Packet

Includes: Plan Summaries for Clarity, PPO, HSA, and Asuris DentalOne Product, Enrollment Forms, Rates, Washington State Health Questionnaire
Includes August 2008 rates.
Click on image to enlarge. Asuris Clarity Brochure

Includes: Clarity Plan Rates, Summary of Benefits, and Overview.
Click on image to enlarge. Asuris Individual Compare Brochure
Click on image to enlarge. Asuris Clarity 50 Plan Summary (Spanish)
Click on image to enlarge. 2008 Asuris Clarity 70 Plan Summary (Spanish)
Click on image to enlarge. 2008 Asuris Clarity 80 Plan Summary (Spanish)
Click on image to enlarge. Asuris Request to Change Form

Includes: Request to Change Form and Business Reply Envelope
Click on image to enlarge. Asuris DentalOne Sales Packet

Includes: DentalOne Plan Summary, Rates, Enrollment Form, Mailing Envelope, and Business Reply Envelope
Click on image to enlarge. Standard Health Questionnaire for effective dates of April 1, 2008 or greater

Includes: Washington State Health Questionnaire and Business Reply Envelope
Click on image to enlarge. Asuris Individual Application (Effective 7/08) - (Ind: 28,33,38)

Includes: Enrollment Application and Business Reply Envelope
Click on image to enlarge. Asuris Electronic Funds Transfer Form(EFT)

Includes: EFT Form and Business Reply Envelope
Click on image to enlarge. Asuris PPO Provider Directory
Asuris Medicare Supplies
Click on image to enlarge. Asuris Medicare Supplement Sales Packet

Includes: Outline of Coverage, Rates, Enollment Application, Plan Overview, and Notice of Replacement Form
Click on image to enlarge. Asuris Medicare Supplement Application (rev 01/08) - (Med: 23,24)

Includes: Regence Medicare Supplement Enrollment Application and Business Reply Envelope
Click on image to enlarge. Asuris Electronic Funds Transfer Form(EFT)

Includes: EFT Form and Business Reply Envelope
Click on image to enlarge. Asuris Notice of Replacement

Includes: Notice of Replacement Form and Business Reply Envelope
Click on image to enlarge. Asuris TruAdvantage Sales Packet

Includes: Summary of Benefits Booklet, Plan Outline, Enrollment Form, Provider Directory, Information Checklist, SurePay Authorization, and Business Reply Envelope
Click on image to enlarge. Asuris TruAdvantage Enrollment Form

Effective June 2008
Click on image to enlarge. Asuris Script Medicare Part D Sales Packet

Includes: Summary of Benefits Booklet, Medicare Drug Plan Brochure, Enrollment Form, Information Checklist, SurePay Authorization, and Business Reply Envelope
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Order materials by filling in the quantities desired
Please allow 7 business days for delivery

Should you need materials not listed on this page,
please contact Individual Marketing at 1 888 344 8234,
or your Sales representative.

 

 
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