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Employing Entity Forms and Reports

Not a Benefits Administrator?

 
This page is intended for benefits administrators at employing entities.

OEBB members click here

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Forms for Employing Entities

 
       ●   2013 Open Enrollment Meeting Request Form NEW online format - easier to submit!

       ●   2013 Open Enrollment Meeting Request Form PDF format

       ●   2013-14 Enrollment Form (Customizable for your entity - Microsoft Word format)​

  revised 2/20/2014

      ​​​ ●   Authorization Agreement for Employer ACH Payments
       ●   Division 60 Social Security Numbers Consent Form
     ​  ●   MyOEBB Rules Selection Form
​       ●   MyOEBB Security Access and Access Termination Form

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Comparability Assessment


       ●   Comparability Assessment Application - revised May 2012 
       ●   Summary of Enrollment Premium Rates - revised May 2012 
       ●   Comparability Policy - revised May 2012 

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Demographic Reports

 

       ●   2008-09 Demographic Report

​       ●   2009-10 Demographic Report
       ●   2010-11 Demographic Report
      ​ ●   2011-12 Demographic Report
       ●   2012-13 Demographic Report
​       ●   2013-14 Demographic Report

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Financial

 
       ●   Electronic Funds Transfer Brochure 
 ​​​      ●   Authorization Agreement for Employer ACH Payments

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Questions & Member Forms


If you have questions, please call OEBB at 888-469-6322
Click here to view member forms.

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