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Group Agents
- Quotes (2-50)
- Quotes (51+)
- Corporate Reports
- Medical Plans
- Dental Plans
- Enrollment
- News
- Forms & Resources
- 503-243-3948 or
800-578-1402
Forms & Resources
Resources
Enrollment for Employer
- Group Application 2-50 (Excel)
- Group Application 2-50 (PDF file)
- Group Application 51+ (Excel)
- Group Application 51+ (PDF file)
- Preauthorized Payment Authorization Form (PDF file)
Enrollment for Employee
Standard Option
- Dental Only Enrollment (PDF file)
- Medical Only Enrollment (PDF file)
- Medical and Dental Enrollment (PDF file)
- Dental and Vision Enrollment (PDF file)
- Affidavit of Domestic Partnership for qualified plans (PDF File)
- Declination of Dental Coverage (PDF file)
- Declination of Medical Coverage (PDF file)
Dual Option
- Dual Option Dental Only 5-99 (PDF file)
- Dual Option Medical Only 5-99 (PDF file)
- Medical and Dual Option Dental 5-99 (PDF file)
- Dual Option Medical and Dental (PDF file)
- Dual Option Medical and Dual Option Dental 5-99 (PDF file)
Oregon Continuation Coverage
- ARRA Premium Reduction Request Form (PDF file)
Renewal
- Oregon Group Profile Form (PDF file)
- Oregon Group Profile Form (Online version)
Quote Request
- Census Form (Excel)
- Census Form (PDF file)
- Proposal Request Form (Excel)
- Proposal Request Form (PDF file)
Claims
- Medical Claim Form (PDF file)
- Dental Claim Form (PDF file)
- Prescription Drug Claim Form for Major Medical Plans (PDF File)
- Prescription Drug Claim Form for Med Impact Plans (PDF File)