To be eligible for the Evergreen Health Insurance Program, you must first be eligible for the Early Intervention Program (EIP). You must also be taking antiretroviral therapy (ART). If you need assistance, contact your HIV case manager, your Evergreen insurance advocate at the numbers listed below, or call EIP directly:

• Download and print the current EIP application (PDF). This application should be submitted directly to EIP.
• EIP's phone number for assistance: 1-877-376-9316 (toll free)

The second step is to fill out an Evergreen Health Insurance Program application. Your insurance advocate or HIV case manager can also help you fill out the paperwork.

• Download and print the current Evergreen application (PDF)
• If you are applying to get insurance assistance for WSHIP or PCIP-WA (see descriptions in the Insurance section), you will also need to complete this Authorization Form (PDF)
• Evergreen's phone number for assistance: 206-323-2834 (King County) or 1-800-945-4256 (toll-free)

When you are filling out the Evergreen application, you must tell us what insurance you have or want. Please see the Insurance section for information on how to apply for insurance. And again, feel free to call us for assistance.

• Be sure to fill the form out completely in pen.
• Do not forget to include the required paperwork as listed on the application.
• Mail the Evergreen application to:

If you are not currently enrolled in either program, you can apply to the Early Intervention Program and the Evergreen Health Insurance Program at the same time. This can speed up your enrollment, but Evergreen can not pay your premiums until you have become eligible for EIP.

If you need help at any time during this process, we at Evergreen are here for you. Call us at 206-323-2834 (King County) or 1-800-945-4256 (toll-free, outside of King County).