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The Episcopal Diocese of Olympia
The Episcopal Church in Western Washington
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Insurance Forms

Medicare Small Payer (MSP) Eligibility Certification Form

Medicare Secondary Payer - Small Employer Exception Eligibility Certification Form

Categories: Insurance Forms, Financial Information for Parishes and Missions, Health Insurance and Employee Benefits, Congregational Finance & Business, Forms

Medicare Small Payer (MSP) Employer Election Form

Medicare Secondary Payer - Small Employer Exception

Categories: Insurance Forms, Financial Information for Parishes and Missions, Health Insurance and Employee Benefits, Congregational Finance & Business, Forms

Waiver of Health Coverage

Waiver for declination to participate on Diocesan health insurance benefits

Categories: Insurance Forms, Financial Information for Parishes and Missions, Health Insurance and Employee Benefits, Congregational Finance & Business, Forms

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