Long-term Care Insurance Exemption

You must apply for and receive an exemption letter from the Washington State Department of Social and Health Services before submitting this form.

Use this form to submit your letter of exemption for long-term care insurance to the City of Bellingham Human Resources Department.

If you would like to complete this form on a mobile phone to make uploading an image of your exemption letter easier, type in “cob.org/LTCinsurance” in your phone’s browser or take a picture of the QR code below using your phone camera: