ODS. Healthcare from your head to your toes.

Group health plan enrollment

We want to make group health plan enrollment as easy as possible for you and your clients. Here, you can download the application and enrollment forms you need to get started. You also can search for available networks.

Learn more about our group medical plans
Learn more about our group dental plans

Producer’s role in group enrollment
Please provide the following information no later than the 20th of the month for an effective date on the first of the following month:

One month’s premium
A completed group medical and/or dental application, signed by both the group and producer
Group Application 2-50 (Excel)
Group Application 2-50
Group Application 51+ (Excel)
Group Application 51+
A completed enrollment or declination form for each eligible employee

Group Size 2-4

Group Size 5-99

Group Size 100+

Affidavit of Domestic Partnership

Affidavit of Domestic Partnership for qualifying plans

Declination of coverage — all eligible individuals waiving coverage must complete a declination of coverage form. Please refer to the eligibility and enrollment guidelines located in the Forms section.

Oregon Continuation Coverage

ARRA Premium Reduction Request Form

ODS’ role in group enrollment
ODS will provide the following information to you:

Upon request, a group application containing the full description of the plan(s) purchased
Enrollment packets (depending on the plan(s) selected, some material may vary)
Benefit summaries
Member enrollment application and change of information form
Note: If a member enrolls in a managed care or point of service medical plan, be sure each member lists a primary care physician (PCP) from the participating provider directory on the enrollment form. Each insured family member may select a different PCP; however, all family members must select PCPs from the same directory.