Oregon Educators Benefit Board OEBB Documents, Forms and Guides

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Oregon Educators Benefit Board

Department

OEBB Documents, Forms and Guides

Appeals

Enrolling in Benefits

Medicare Creditable and Noncreditable Coverage Notices

Member Affidavits and Forms

MyOEBB Forms

Member Guides

MyOEBB Guides

Premium Collection Forms and Documents

Reimbursement Forms

Reports

Transition of Care Forms

Can't find it?

Appeals

Download the appeal form, complete, and return to OEBB. If you have questions, please call OEBB at (888) 469-6322. To submit an appeal by e-mail, write to OEBB.appeals@state.or.us.

Appeal Form

View the OEBB Complaint and Appeal Administrative policy.

Enrolling in Benefits

Download the enrollment form, complete, and return to your educational entity. This form may be used to enroll in benefits instead of the online MyOEBB enrollment system. If you have questions, please call OEBB at (888) 469-6322.

Enrollment Form
Optional Enrollment Form Plan Year 2009
2009 Enrollment Brochure

Medicare Creditable and Noncreditable Coverage Notices

These notices contain information about current prescription drug coverage with Oregon Educators Benefit Board and about individual's options under Medicare’s prescription drug coverage. If you have questions, please call OEBB at (888) 469-6322.

Medicare Creditable Coverage Notice

Medicare Noncreditable Coverage Notice

Member Affidavits and Forms

Download the affidavits or termination forms, complete, and return to your educational entity. If you have questions, please call OEBB at (888) 469-6322.

Affidavit of Dependency

Affidavit of Domestic Partnership

Termination of Domestic Partnership

Group Life Conversion Request Form

Group Life Portability Application


MyOEBB Forms

For Education Entities: Click on the link to access the documents, to download, or to print. If you have questions, please call OEBB at 888-469-6322. MyOEBB Rules Selection Form MyOEBB Security Access and Access Termination Form MyOEBB Systems Training Registraton 2009 SSN Consent Form


Member Guides

2009 Enrollment Brochure 2009 Member Guide MyOEBB New Hire Enrollment Guide


MyOEBB Guides

For Education Entities: Click on the link to access the MyOEBB Guides, download, or print. If you have questions, please call OEBB at 888-469-6322. Adding a Dependent Employment Change: Active to Retiree Imputed Values Mass Lock Out MyOEBB Educational Entity Administrator Guide MyOEBB New Hire Enrollment Guide QSC Detailed Matrix Guide Permanent File Format Process QSC Dates and 90-Day Credits Removing a Dependent Terminating an Employee by QSC with Benefits Enrollments


Premium Collection Forms and Documents

For Educational Entities: Click on the links to access the premium collection forms and documents for educational entities, download, or print. If you have questions, please call OEBB at 888-469-6322. Debit Agreement Form Electronic Funds Transfer Brochure Payment Election Form


Reimbursement Forms

Click on the link to access the reimbursement forms, download, or print. If you have questions, please call OEBB at 888-469-6322. Reimbursement Form -- Kaiser Permanente Reimbursement Forms -- ODS medical, dental, vision and pharmacy Reimbursement Form -- Providence


Reports

For Educational Entities: Click on the links to access reports for educational entities, to download, or to print. If you have questions, please call OEBB at 888-469-6322. 2008-09 Demographic Report


Transition of Care Forms

Click on the link to access the transition of care forms, download, or print. If you have questions, please call OEBB at 888-469-6322. ODS Transition of Care Providence Transition of Care


Can't find it?

Click here to view DAS' master forms page.

Page updated: November 04, 2009

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