Plan Documents - Cascade Select powered by CHPW - Cascade Select

Plan Documents

The documents below explain exactly what your plan covers and what it does not include, how much you have to pay for care, how to access health care, and much more. You can click on the links to view the form online or download it. If you need a hard copy mailed to you, call Customer Service at 1-866-907-1906.

Plan documents

Evidence of Coverage (EOC)

The EOC is also known as the Health Care Coverage Agreement. It is a binding contract that describes the health care benefits available to you, and your rights and responsibilities, under your plan.

Schedule of Benefits (SB)

The SB details the fees associated with each type of health care service covered by your plan. This includes your deductible and out-of-pocket maximum amounts.

Summary of Benefits and Coverage (SBC)

The SBC gives a snapshot, in plain language, of your health plan’s costs, benefits, covered health care services, and other features.

Electronic Funds Transfer (EFT) Authorization Form

Our secure E-Bill Express payment portal allows you to pay your monthly premiums and medical bills online. If you prefer not to use the online payment system, you can submit payment by Electronic Funds Transfer (EFT). Use the form below to notify us if you prefer this payment option.

Standard Consumer Notice

Know your rights under the Balance Billing Protection Act. Beginning January 1, 2020, Washington state law protects you from ‘surprise billing’ or ‘balance billing’ if you receive emergency care or are treated at an in-network hospital or outpatient surgical facility.

Member Rights Forms

As a Cascade Select member, you have certain rights designed to protect you when you get health care.

Appointing a Representative

An appointed representative is a relative, friend, advocate, doctor, or another person who is authorized to act on your behalf in obtaining a grievance, coverage determination, or appeal. If you would like to appoint a representative, both you and your representative must complete the form and mail it to Community Health Network of Washington.

Appointment of Representative

Completed forms can be mailed to:

Community Health Network of Washington Cascade Select
1111 Third Avenue, Suite 400
Seattle, WA 98101

DID YOU KNOW...?

Stay on Top of Your Prescriptions

Woman grabbing a prescriptionDid you know that certain prescription medicines are available as a 90-day supply? Medicine that you take on a long-term basis to manage your health is called a “maintenance drug.” A 90-day supply makes it easier to keep taking the medicine you need to feel your best. You may also be eligible to receive your long-term medications through free home delivery.

LEARN MORE