How to Apply

To be eligible for the Evergreen Health Insurance Program, you must first be eligible for the Early Intervention Program (EIP) or EIP's Pre-Exposure Prophylaxis Drug Assistance Program (PrEP DAP). If you need assistance, contact your HIV case manager, your Evergreen insurance advocate at the numbers listed below, or call EIP or PrEP DAP directly at (877) 376-9316.

  • If you are not yet enrolled in EIP, download and print the dual application for EIP and the Evergreen Health Insurance Program (PDF) and submit it directly to EIP only.  (If you want Evergreen's assistance with medical insurance premiums, be sure to complete Section 3.)
  • If you are interested in applying for EIP's PrEP DAP program, you will need to download and print this specific application in English or Español. If you are approved for PrEP DAP, EHIP may be able to assist you in enrolling and paying for your insurance. If you already have insurance, please write this information on your PrEP DAP application (this information will be forwarded to EHIP).
  • If you are currently enrolled in the EIP or PrEP DAP program, download and print the Evergreen New Enrollment/New Payable application and then submit it to Evergreen only.  You can mail or fax the completed application.  Evergreen's fax number is (206) 323-0158.  Evergreen's mailing address is:

Evergreen Health Insurance Program
P.O. Box  80547
Seattle, WA   98108-0547

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.

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).