Oregon small group enrollment forms

2023

• 2023 Total Enhanced, Balance, Standard, HSA, or HSA Qualified plans (PDF)
• 2023 Connect or Choice plans (PDF)
• 2023 Total Enhanced, Balance, Standard, HSA, or HSA Qualified plans – Spanish (PDF)
• 2023 Connect or Choice plans – Spanish (PDF)

2022

• 2022 Total Enhanced, Balance, Standard, HSA, or HSA Qualified plans (PDF)
• 2022 Connect or Choice plans (PDF)
• 2022 Total Enhanced, Balance, Standard, HSA, or HSA Qualified plans – Spanish (PDF)
• 2022 Connect or Choice plans – Spanish (PDF)

Other Oregon small group forms

• 2023 Oregon standardized group size determination form (PDF)
• SHOP Participation Request form (PDF)

Oregon large group enrollment forms

2023

• 2023 Choice, Connect or HSA Connect plans (PDF)
• 2023 Option Advantage, HSA, or Personal Option plans (PDF)
• 2023 Choice, Connect, or HSA Connect plans – Spanish (PDF)
• 2023 Option Advantage Base, Option Advantage Plus, Option Advantage Premium, Personal Option or Integrated HSA plans – Spanish (PDF)

2022

• 2022 Choice, Connect, or HSA Connect plans (PDF)
• 2022 Option Advantage Base, Option Advantage Plus, Option Advantage Premium, Personal Option or Integrated HSA plans (PDF)
• 2022 Choice, Connect, or HSA Connect plans – Spanish (PDF)
• 2022 Option Advantage Base, Option Advantage Plus, Option Advantage Premium, Personal Option or Integrated HSA plans – Spanish (PDF)

Washington enrollment forms

2023

• 2023 Choice plans (PDF)
• 2023 Choice plans - Spanish (PDF)
• 2023 Option Advantage Base, Option Advantage Plus, Option Advantage Premium, Personal Option or Integrated HSA plans (PDF)
2023 Option Advantage Base, Option Advantage Plus, Option Advantage Premium, Personal Option or Integrated HSA plans - Spanish (PDF)

2022

• 2022 Choice plans (PDF)
• 2022 Option Advantage Base, Option Advantage Plus, Option Advantage Premium, Personal Option or Integrated HSA plans (PDF)
• 2022 Choice plans - Spanish (PDF)
• 2022 Option Advantage Base, Option Advantage Plus, Option Advantage Premium, Personal Option or Integrated HSA plans - Spanish (PDF)

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

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.

• Continuation of coverage (COBRA, state continuation of coverage, portability plans) (PDF)
• State continuation election form (PDF)
• COBRA continuation election form (PDF)

• Requesting access to one's health plan records (PDF)
• Changing and restricting access to one's health plan records (PDF)
• Request for Confidential Communications - Oregon (PDF)
• Request for Confidential Communications - Washington (PDF)
• Allowing others to share one's protected health information(PDF)

• Groups sized 50+ Health Coaching Toolkit (PDF)
• Groups sized 50+ Primary Care Provider Toolkit (PDF)

2023 plan overviews

• Employer groups 1-50 (PDF)
• Employer groups 51+ (PDF)

2022 plan overviews

• Employer groups 1-50 (PDF)
• Employer groups 51+ (PDF)

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)