Be sure groups use the correct waiver form version

March 03, 2025

Please advise your groups to always use the correct waiver form version for their needs. Each eligible employee who chooses to not enroll in their employer group health plan must complete a coverage waiver form. The form demonstrates that the employer is offering coverage to all eligible employees. We use it to accurately calculate their participation.

You can find all coverage waiver forms under Forms & Documents on regence.com. The correct versions are dated either 9/2024 or 1/2025 at the bottom, depending on the state and group size.

Spanish-language forms are available for Oregon and Washington groups. Note that for small groups (<51) in Idaho and Utah and for midsize groups (51-100) in Utah, the waiver option is on groups’ enrollment forms; there is no separate form.

Questions? Please contact your account representative.