Forms & documents

Enrollment, change of status, & waiver of coverage forms
Oregon Small Group enrollment forms

2026
2025
Other Oregon Small Group forms
- Oregon group size determination form (PDF)
- SHOP Participation Request form (PDF)
Oregon Large Group enrollment forms

2026
2025
Washington enrollment forms

2026
2025
Forms for all groups
- Out-of-area dependent enrollment (PDF)
- Transition of care (PDF)
- Other member forms and notices
- Medical home selection form (PDF)
- Medical home selection form - Spanish (PDF)
- Enrollment spreadsheet (ZIP)
- Employer reconciliation worksheet (PDF)
Vision claim form
- VSP reimbursement form (PDF)
  (Use when services are rendered by a non-VSP provider)
- Vision claim form (PDF)
  (Use if you have a Vision $200, Vision $300 or Vision $400 plan administered by Providence Health Plan)
Continuation of coverage forms
Termed members may be eligible for continued coverage. The following resources will help administrators determine continuation of coverage eligibility and steps to take to continue coverage.
Health information disclosure forms
Employer Information Guides
Employer Groups 1-50
- 2025 Small Group Employer Onboarding Guide (PDF)
- 2026 Small Group Employer Onboarding Guide (PDF) – coming soon
Employer Groups 51+
- 2025 Large Group Employer Onboarding Guide (PDF)
- 2026 Large Group Employer Onboarding Guide (PDF) – coming soon
Group size questionnaire
The group size questionnaire is used to determine if Medicare pays primary or secondary to your group health plan coverage. It is also used to determine continuation of coverage.
- Annual group size questionnaire (PDF)

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Forms & documents

Enrollment, change of status, & waiver of coverage forms

Oregon Small Group enrollment forms

Other Oregon Small Group forms

Oregon Large Group enrollment forms

Washington enrollment forms

Forms for all groups

Continuation of coverage forms

Health information disclosure forms

Employer Information Guides

Employer Groups 1-50

Employer Groups 51+

Group size questionnaire

SALES & ENROLLMENT SUPPORT

Need options? Got questions? We’ve got answers.

Employer Hub

Tools and resources to help you manage your plan