Español
Forms
Claims
Dental Claim Form
Medical/Vision Claim Form
Prescription Drug Claim Form for Major Medical Plans - plans with pharmacy benefits administered under medical plan
Prescription Drug Claim Form for Med Impact Plans - plans with retail prescription drug benefit
Tobacco Cessation Claim Form
Individual Enrollment/Changes
Group Enrollment/Changes (through employer)
Standard Option
- Dental Only Enrollment
- Medical Only Enrollment
- Medical and Dental Enrollment
- Medical with PCP Enrollment
- Dental and Vision Enrollment
- Affidavit of Domestic Partnership for qualified plans
- Declination of Dental Coverage
- Declination of Medical Coverage
Dual Option
- Dual Option Dental Only 5-99
- Dual Option Medical Only 5-99
- Dental and Dual Option Medical
- Dual Option Dental and Medical
- Dual Option Medical and Dual Option Dental 5-99
Oregon Continuation Coverage
HIPAA/Privacy Forms
- Authorize ODS to use/disclose information
about a member - Instructions
- Authorize Provider or Hospital
to use/disclose information to ODS - Instructions