2021 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

Forms for all groups

Oregon small-group forms

View 2020 forms ›

Change forms for individual and family insurance plans

2021 Oregon plans

  • 2021 online Special Enrollment change form for individual and family insurance (PDF)
  • 2021 fillable change form for individual and family insurance (PDF)
    (Use if your client needs to list more than four dependents.)

2021 Washington plans

For changes to current 2021 coverage, visit WaHealthPlanFinder.org.

  • 2021 fillable change form for Individual and family insurance PDF)

Enrollment forms for individual and family plans

2021 plans

  • Fillable application for Oregon individual and family insurance (PDF)
  • Fillable application for Washington individual and family insurance (PDF)

Medicare forms

Secret shopper surveillance tools

Health information disclosure forms for all groups