Forms & documents

Enrollment, change of status, & waiver of coverage forms
Oregon small group enrollment forms

2021
2020
Other Oregon small group forms
- 2021 Oregon standardized group size determination form (PDF)
- SHOP Participation Request form (PDF)
Oregon large group enrollment forms

2021
2020
Washington enrollment forms

2021
2020
- 2020 Washington plans (PDF)
- 2020 Washington plans - Spanish (PDF)
Forms for all groups
- 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)
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 toolkits
- Groups sized 50+ Health Coaching Toolkit (PDF)
- Groups sized 50+ Primary Care Provider Toolkit (PDF)
Plan overviews
2021 plan overviews
- Employer groups 1-50 (PDF)
- Employer groups 51+ (PDF)
2020 plan overviews
- Employer groups 1-50 (PDF)
- Employer groups 51+ (PDF)