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Evergreen Security Trust
FORMS & PLAN SUMMARIES
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For further information please contact our general agent:
DiMartino Associates
Century Square Building
1501 Fourth Avenue, Suite 2400
Seattle. WA 98101
Phone:   206-623-2430
Fax:       206-812-7550
Email:     Evergreen Security Trust
If you wish to become eligible for an EST quote, please click on the link below.
EST Eligibility
Forms & Plan Summaries
MEDICAL
2012
Medical Plan Comparison 2012
Dual Choice Matrix 2012
Summary of Regulatory & Language Changes 2012
 
PPO 250a - Benefit Summary
PPO 350 - Benefit Summary
PPO 350a - Benefit Summary
PPO 500 - Benefit Summary
PPO 750 - Benefit Summary
PPO 1000 - Benefit Summary
PPO 1500 - Benefit Summary
PPO 2000 - Benefit Summary
PPO 2500 - Benefit Summary
PPO 3000 - Benefit Summary
T50/$3,500 - Benefit Summary
T50/$10,000 - Benefit Summary
T50/$3,000 Deductible - Benefit Summary
T50/$3,000 Deductible (Waived on RX)- Benefit Summary
HSA 1500 - Benefit Summary
HSA 2500 - Benefit Summary
HSA 3500 - Benefit Summary
Vision Rider Summary
 
PPO 250 – Plan Booklet
PPO 250a – Plan Booklet
PPO 350 – Plan Booklet
PPO 350a – Plan Booklet
PPO 500 – Plan Booklet
PPO 750 – Plan Booklet
PPO 1000 – Plan Booklet
PPO 1500 – Plan Booklet
PPO 2000 – Plan Booklet
PPO 2500 – Plan Booklet
PPO 3000 – Plan Booklet
T50 3500 – Plan Booklet
T50 3000 Deductible (Waived on Rx) – Plan Booklet
T50 3000 – Plan Booklet
T50 10000 – Plan Booklet
HSA 1500 – Plan Booklet
HSA 2500 – Plan Booklet
HSA 3500 – Plan Booklet
 
2012 INSERTS
PPO 250a
PPO 350, 350A, 500
PPO 750, 1000, 2000, 2500, 3000
T50 3500, T50 10000
T50 3000 Deductible (Waived on Rx)
HSA 1500, 2500, 3500
 
 DENTAL
2011/2012
EST Plan I

EST Plan II

EST Plan III
EST Plan IV

Ortho Option All Plans - Benefit Summary

Domestic Partner Definition
Dental Plan Comparison 2011/2012
 
 LIFE

Life & AD&D - Benefit Summary

Life & AD&D $10,000 - Benefit Summary

Life & AD&D $25,000 - Benefit Summary
Life & AD&D $50,000 - Benefit Summary
EST Death Claim Form
 
 GENERAL
2012
Administration Guide
Broker Manual
Master Application
Master Application - Asuris
Employee Application
Employee Application - Asuris
Deductible Credit Form - Regence
Deductible Credit Form - Asuris
COBRA Agreement
Domestic Partner Affidavit
Late Submission Letter
New Group Checklist
 
 
Forms & Plan Summaries