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

To make changes to your client's 2021 coverage during Open Enrollment, use the links below. With this form, they can change their plan, add or remove dependents, or terminate coverage. If they have a Marketplace policy, go to HealthCare.gov to help them make changes.

2020 Oregon plans

If your client has experienced a recent qualifying event, they may shop, compare and enroll in a 2020 plan.

To make changes to your client's 2020 coverage, use the links below. With this form, they can change their plan, add or remove dependents, or terminate coverage. If they have a Marketplace policy, go to HealthCare.gov to help them make changes.

2021 Washington plans

To make changes to your client’s 2021 coverage during Open Enrollment, use the links below. With this form, they can change their plan, add or remove dependent, or terminate coverage. If they have a Washington Health Benefits Exchange policy, go to WaHealthplanfinder.org to help them make changes.

2020 Washington plans

If your client has experienced a recent qualifying event, they may shop, compare and enroll in a 2020 plan.

To make changes to your client’s 2020 coverage, use the links below. With this form, they can change their plan, add or remove dependent, or terminate coverage. If they have a Washington Health Benefits Exchange policy, go to WaHealthplanfinder.org to help them make changes.

Enrollment forms for individual and family plans

2021 Oregon plans

2021 Washington plans

Medicare forms

Secret shopper surveillance tools

Health information disclosure forms for all groups