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This version of the form is not currently in use and is provided for reference only. Download this version of
Form HCA20-0045
for the current year.
Form HCA20-0045 Sebb Electronic Debit Service Agreement - Washington
What Is Form HCA20-0045?
This is a legal form that was released by the Washington State Health Care Authority - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form HCA20-0045?
A: Form HCA20-0045 is the Sebb Electronic Debit Service Agreement for the state of Washington.
Q: What does the form cover?
A: The form covers the electronic debit service agreement for the Sebb program in Washington.
Q: What is the purpose of the form?
A: The form is used to authorize electronic debits for premium payments in the Sebb program.
Q: Do I need to fill out this form?
A: If you are participating in the Sebb program in Washington and want to authorize electronic debits for premium payments, then you need to fill out this form.
Form Details:
- Released on July 1, 2022;
- The latest edition provided by the Washington State Health Care Authority;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form HCA20-0045 by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.
Download Form HCA20-0045 Sebb Electronic Debit Service Agreement - Washington
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