-
Employers
- ODS Plans
- Employer Online Services
- Value-Added Services
- Third Party Administration
- Group Administrator Guide (PDF)
- Samples & Forms
- Need Help?
- Medical
- 503-243-3962 or
877-605-3229 - Dental
- 503-265-5680 or
877-277-7280 - Employer Online Services
- 503-265-5691 or
877-277-7075
Commercial Preferred Provider Organization
NCQA is committed to providing healthcare quality information through the web and the media to help consumers, employers and others make more informed healthcare choices.
Samples & Forms
Samples
- Dental Explanation of Benefits (EOB) (PDF file)
- Dental Explanation of Benefits (EOB) en Español (PDF file)
- Medical Explanation of Benefits (EOB) (PDF file)
- Sample Bill (PDF file)
- Saving Money
on Your Healthcare Benefits (PDF file)
Maximize Your Benefits Handout: Color | Black & White
Maximize Your Benefits Poster: Color | Black & White
Forms
Claims
- Prescription Drug Claim Form for Major Medical Plans (PDF file)
- Prescription Drug Claim Form for Med Impact Plans (PDF file)
Declination of coverage
- Declination of Dental (PDF file)
- Declination of Medical (PDF file)
Insurance through employer
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)
Administrative