Forms
Enrollment forms — group (for employer)
- Group Application 2-50 (Excel)
- Group Application 2-50
- Group Application 51+ (Excel)
- Group Application 51+
- Oregon Group Profile Form (Online)
- Oregon Group Profile Form (Downloadable)
- Preauthorized Payment Authorization Form
Enrollment — group (for employee)
Group Size 2-4
Group Size 5-99
- Dental Only
- Dental Only (Spanish)
- Medical Only
- Dual Medical
- Medical and Dental
- Medical and Dental (Spanish)
- Dual Medical and Dental
Group Size 100+
- Dental Only
- Medical Only
- Dual Medical
- Medical and Dental
- Dual Medical and Dental
- Dental and Vision
- Dual Medical w/PCP and Dental
Enrollment forms — individual
- Individual Medical & Dental Enrollment (Online Application)
- Individual Medical & Dental Enrollment
- Individual Dental Application
- Dental Exchange Application
- Authorization Agreement for AutoPay (EFT)
- ODS Individual Underwriting Field Guide
Affidavit of Domestic Partnership
- Affidavit of Domestic Partnership for qualifying plans
Declination of coverage
Oregon Continuation Coverage
2010 Renewal Information
2011 Individual Plans Renewal Information
Quote Request
- Census Form (Excel)
- Census Form
- Proposal Request Form (Excel)
- Proposal Request Form
- Business Verification Statement Requirement (2-4pp)
Claims
Log in to Benefit Tracker
Check benefits and eligibility
Log in to Benefit Tracker
Check benefits and eligibility
Shopping for health insurance?
Shopping for health insurance?
