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Employers
- ODS Plans
- Employer Online Services
- Value-Added Services
- Third Party Administration
- Group Administrator Guide (PDF)
- Samples & Forms
- Need Help?
- Medical
- 503-243-3962 or
877-605-3229 - Dental
- 503-265-5680 or
877-277-7280 - Employer Online Services
- 503-265-5691 or
877-277-7075
Samples & Forms
Samples
- Dental Explanation of Benefits (EOB) (PDF file)
- Dental Explanation of Benefits (EOB) en Español (PDF file)
- Medical Explanation of Benefits (EOB) (PDF file)
- Sample Bill (PDF file)
- Saving Money
on Your Healthcare Benefits (PDF file)
Maximize Your Benefits Handout: Color | Black & White
Maximize Your Benefits Poster: Color | Black & White
Forms
Claims
- Prescription Drug Claim Form for Major Medical Plans (PDF file)
- Prescription Drug Claim Form for Med Impact Plans (PDF file)
Declination of coverage
- Declination of Dental (PDF file)
- Declination of Medical (PDF file)
Insurance through employer
Standard Option
- Dental Only Enrollment (PDF file)
- Medical Only Enrollment (PDF file)
- Medical and Dental Enrollment (PDF file)
- Affidavit of Domestic Partnership for qualified plans (PDF File)
- Declination of Dental Coverage (PDF file)
- Declination of Medical Coverage (PDF file)
Dual Option
- Dual Option Dental Only 5-99 (PDF file)
- Dual Option Medical Only 5-99 (PDF file)
- Medical and Dual Option Dental 5-99 (PDF file)
- Dual Option Medical and Dental (PDF file)
- Dual Option Medical and Dual Option Dental 5-99 (PDF file)
Administrative