2020 forms

To view, fill out and print the forms on this page, you will need the latest version of Adobe Acrobat Reader, which can be downloaded. However, Adobe Acrobat Reader does not allow you to save your completed, or partially completed, forms to a disk or on your computer. For that expanded capability you will need to have the complete Adobe Acrobat software package, version 5.0 or later.

Enrollment/change of status/waiver of coverage forms

Oregon small groups

Choose your small group plan: 

Oregon large groups

Choose your large group plan:

Washington plans

  • 2020 Washington plans (PDF coming soon)
  • 2020 Washington plans – Spanish (PDF coming soon)

Forms for all groups - coming soon

  • Out-of-area dependent enrollment (PDF)
  • Transition of care (PDF)
  • Other member forms and notices
  • Medical home selection form (PDF)
  • Enrollment spreadsheet (ZIP)
  • HealthEquity HRA/HSA standard new business notification form (PDF)

Oregon small-group forms - coming soon

  • 2020 small group enrollment kit (PDF)
    Packaged together in a single PDF, the enrollment kit contains all the forms you’ll need for Oregon small group enrollment: the master contract application, Oregon group size determination (GSD) form, enrollment/change of status/waiver form, medical home selection form (for Connect products only), and underwriting guidelines.
  • 2020 master contract application (PDF)
  • 2020 producer checklist for small group enrollment (PDF)
  • 2020 small group underwriting guidelines (PDF)
  • 2020 Oregon standardized group size determination form (PDF)

View 2019 forms ›

2019 change forms for individual and family insurance plans

Medicare forms

Secret shopper surveillance tools

Health information disclosure forms for all groups