WEA Termination Notification Form
(For use before your billing is returned to Premera)
Please help us by updating your terminating employees’ records in a timely fashion. Complete this form by checking all products being dropped, based on the following:
Send the completed form to your WEA/APA Billing Representative by e-mail or fax to 425-918-5204.
Is a subscriber being terminated due to his/her death? If yes, who?