Enrollment Forms & Info
Kaiser Medical
2025 PLANS
2025 Kaiser Plans One Page Summary
NEW! – 2025 HMO Z2 5000 Benefit Summary
NEW! – 2025 HMO Silver 3000 SBC
NEW! – 2025 HMO Silver 3000 Benefit Summary
NEW! – 2025 PPO HSA 2500 Benefit Summary
2025 Access PPO Diamond 500 SBC
2025 Access PPO Diamond 500 Benefit Summary
2025 Access PPO Emerald 1000 SBC
2025 Access PPO Emerald 1000 Benefit Summary
2025 Access PPO Sapphire 1500 SBC
2025 Access PPO Sapphire 1500 Benefit Summary
2025 Core HMO Pearl 2500 Benefit Summary
2025 Access PPO Ruby 3000 Benefit Summary
2025 Access PPO Opal 5000 Benefit Summary
2025 Core HMO Onyx 5000 Benefit Summary
2025 Core HMO Jade Benefit Summary
2025 Core HMO Topaz 5000 Benefit Summary
2025 HSA Core 2500 Benefit Summary
2025 Access PPO Quartz 2500 SBC
2025 Access PPO Quartz 2500 Benefit Summary
2025 Core HMO Zircon 5000 Benefit Summary
2025 Virtual Plus 1000 Benefit Summary
2025 Virtual Plus 2000 Benefit Summary
2025 Virtual Plus 3000 Benefit Summary
2025 Virtual Plus 5000 Benefit Summary
2024 PLANS
Kaiser Medical (Spanish)
Ameritas Vision
2025 Plans
HHI 2025 Benefit Summary – Vision Plans
HHI 2025 Ameritas Vision Plan 1
HHI 2025 Ameritas Vision Plan 2
HHI 2025 Ameritas Vision Plan 3
HHI 2025 Ameritas Vision Plan 4
HHI 2025 Ameritas Vision Plan 5
HHI 2025 Ameritas Vision Plan 6
HHI 2025 Ameritas Vision Plan 7
HHI 2025 Ameritas Vision Plan 8
HHI 2025 Ameritas Vision Plan 9
HHI 2025 Ameritas Vision Plan 10
2024 Plans
HHI 2024 Benefit Summary – Vision Plans
HHI 2024 Ameritas Vision Plan 1
HHI 2024 Ameritas Vision Plan 2
HHI 2024 Ameritas Vision Plan 3
HHI 2024 Ameritas Vision Plan 4
HHI 2024 Ameritas Vision Plan 5
HHI 2024 Ameritas Vision Plan 6
HHI 2024 Ameritas Vision Plan 7
HHI 2024 Ameritas Vision Plan 8
HHI 2024 Ameritas Vision Plan 9
HHI 2024 Ameritas Vision Plan 10
EyeMed English Vision Claim Form
Ameritas Vision Claim Form (English)
Ameritas Vision Claim Form (Spanish)
Ameritas Vision Enrollment Waiver Form
Ameritas Vision (Spanish)
2024 Plans
HHI 2024 Ameritas Vision Plan 1 (Spanish)
HHI 2024 Ameritas Vision Plan 2 (Spanish)
HHI 2024 Ameritas Vision Plan 3 (Spanish)
HHI 2024 Ameritas Vision Plan 4 (Spanish)
HHI 2024 Ameritas Vision Plan 5 (Spanish)
HHI 2024 Ameritas Vision Plan 6 (Spanish)
HHI 2024 Ameritas Vision Plan 7 (Spanish)
HHI 2024 Ameritas Vision Plan 8 (Spanish)
Quoting Forms
Hospitality Health Insurance Dental
2025 Plans
HHI 2025 Benefit Summary – Willamette Dental HIGH Option
HHI 2025 Benefit Summary – Willamette Dental LOW Option
HHI 2025 Benefit Summary – Ameritas Dental
2024 Plans
HHI 2024 Benefit Summary – Willamette Dental HIGH Option
HHI 2024 Benefit Summary – Willamette Dental LOW Option
HHI 2024 Benefit Summary – Ameritas Dental
Ameritas Dental Claim Form (English)
Hospitality Health Insurance Enrollment Applications
HHI 2024 Participation Agreement
HHI 2025 Participation Agreement
HHI 2024 Enrollment and Change Form (English)
HHI 2025 Enrollment and Change Form (English)
Transamerica Basic Life Beneficiary Form
Waiver of Health Coverage (English)
Waiver of Health Coverage (Español)
Notice of Late Submission and Request for Processing Exception
Ameritas Dental Benefit Summaries
2025 PLANS
Ameritas Benefit Summary Plan 1
Ameritas Benefit Summary Plan 2
Ameritas Benefit Summary Plan 3
Ameritas Benefit Summary Plan 4
Ameritas Benefit Summary Plan 5
Ameritas Benefit Summary Plan 6
Ameritas Benefit Summary Plan 7
Ameritas Benefit Summary Plan 1 – ortho
Ameritas Benefit Summary Plan 2 – ortho
Ameritas Benefit Summary Plan 3 – ortho
Ameritas Benefit Summary Plan 4 – ortho
Ameritas Benefit Summary Plan 5 – ortho
Ameritas Benefit Summary Plan 6 – ortho
Ameritas Benefit Summary Plan 7 – ortho
2024 PLANS
Ameritas Benefit Summary plan 1 no rates
Ameritas Benefit Summary plan 2 no rates
Ameritas Benefit Summary plan 3 no rates
Ameritas Benefit Summary plan 4 no rates
Ameritas Benefit Summary plan 5 no rates
Ameritas Benefit Summary plan 6 no rates
Ameritas Benefit Summary plan 7 no rates
Ameritas Benefit Summary plan 1 HIGH ortho
Ameritas Benefit Summary plan 1 LOW ortho
Ameritas Benefit Summary plan 1 MED ortho
Ameritas Benefit Summary plan 2 HIGH ortho
Ameritas Benefit Summary plan 2 LOW ortho
Ameritas Benefit Summary plan 2 MED ortho
Ameritas Benefit Summary plan 3 HIGH ortho
Ameritas Benefit Summary plan 3 LOW ortho
Ameritas Benefit Summary plan 3 MED ortho
Ameritas Benefit Summary plan 4 HIGH ortho
Ameritas Benefit Summary plan 4 LOW ortho
Ameritas Benefit Summary plan 4 MED ortho
Ameritas Benefit Summary plan 5 HIGH ortho
Ameritas Benefit Summary plan 5 LOW ortho
Ameritas Benefit Summary plan 5 MED ortho
Ameritas Benefit Summary plan 6 HIGH ortho
Ameritas Benefit Summary plan 6 LOW ortho
Ameritas Benefit Summary plan 6 MED ortho
Ameritas Benefit Summary plan 7 HIGH ortho
Additional Hospitality Health Insurance Services
Ameritas Dental Benefit Summaries (Spanish)
2024 PLANS
Ameritas Benefit Summary plan 1 no rates
Ameritas Benefit Summary plan 2 no rates
Ameritas Benefit Summary plan 3 no rates
Ameritas Benefit Summary plan 4 no rates
Ameritas Benefit Summary plan 5 no rates
Ameritas Benefit Summary plan 6 no rates
Ameritas Benefit Summary plan 7 no rates
Ameritas Benefit Summary plan 1 HIGH ortho
Ameritas Benefit Summary plan 1 LOW ortho
Ameritas Benefit Summary plan 1 MED ortho
Ameritas Benefit Summary plan 2 HIGH ortho
Ameritas Benefit Summary plan 2 LOW ortho
Ameritas Benefit Summary plan 2 MED ortho
Ameritas Benefit Summary plan 3 HIGH ortho
Ameritas Benefit Summary plan 3 LOW ortho
Ameritas Benefit Summary plan 3 MED ortho
Ameritas Benefit Summary plan 4 HIGH ortho
Ameritas Benefit Summary plan 4 LOW ortho
Ameritas Benefit Summary plan 4 MED ortho
Ameritas Benefit Summary plan 5 HIGH ortho
Ameritas Benefit Summary plan 5 LOW ortho
Ameritas Benefit Summary plan 5 MED ortho
Ameritas Benefit Summary plan 6 HIGH ortho
Ameritas Benefit Summary plan 6 LOW ortho
Ameritas Benefit Summary plan 6 MED ortho
Ameritas Benefit Summary plan 7 HIGH ortho
Hospitality Health Insurance Broker Resource Guide
Contact Information
Contact Information
Kaiser Permanente Washington Customer Service: (888) 901-4636
Ameritas Customer Service: 800.487.5553
Willamette Customer Service: 855.433.6825
TransAmerica Customer Service: 800.797.2643
Teladoc Customer Service: 800.835.2362
ComPsych Customer Service: 877.357.4322
Vimly Benefit Solutions: 206-456-9940
H.I.H.I.T.: 866-897-0488
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