MEMBERS ONLY FORMS


Claims Forms
Form Name Description:
Beneficiary Statement Use this form, if you are a Beneficiary, Trustee or the party concerned with completing or filing a claim for a deceased WAEPA Member.
Dependent Group Life Benefits
Proofs of Death 		Use this form, if you are a Member who is completing or filing a claim for a deceased Dependent under your plan.
Multiple Beneficiary Statement Use this form, if you are filing a claim for more than one beneficiary and you need to add their names to the claim you are filing.
Verification of Trust Use this form, if a Trust was named as a beneficiary by the deceased Member.


Adjust Your Coverage
Form Name

For:

Description:

Change Your Name

Current WAEPA members

Use this form to update the name on your policy.

Change Your Address

Use this form to update the address on your policy.

Change Your Beneficiary

Use this form to change your beneficiary.

Increase Your  Coverage

Use this form to increase the amount
of your current WAEPA coverage. If you add coverage for your domestic partner, please attach a domestic partner affidavit.

Decrease Your Coverage

Use this form to reduce the amount of your current WAEPA coverage.

Payment Processing Center

Use this address to mail payment on your existing WAEPA bill. If you are not currently a WAEPA insured member, do not use this address. Please include your 5 to 6 digit WAEPA Certificate Number in the memo of your check.