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Forms

We're here for you. Member to member.

In this brave new world PEBB understands the need for convenient information and efficiencies. We are currently working to make all our forms fillable. As we make forms fillable, they will be identified in the description column.

Filling in forms:

  1. Use the Form page instructions, if needed, to help find the form you need.
  2. Open the form by clicking the Title.
  3. Download the form to your computer.
  4. Open the form on your computer and be sure to fill in all Required Fields. 
  5. Save your PDF!
  6. The last page of each form has information about where to Send it.

Not sure which form to fill out or have other benefit related questions?  
Contact Member Services at (503) 373-1102 or inquiries.pebb@dhsoha.state.or.us. 

We are experiencing a higher than normal call volume. Please leave a message for Member Services and they will return your call within 24-48 hours, or you may choose to email your question instead. 

We want to be supportive! For the best experience, please do not view this page in Internet Explorer.
 




Form page Instructions:

  1. Search
      • Enter keywords in the Search box, (example: mid-year change, divorce, affidavit, enrollment, fsa, etc.)
    1. Sort
      • Click desired column Header (example: category, url, description, form number) to sort or;
      • Use Sort dropdown and choose a different column to sort A-Z.
    2. Filter 
      • Click Filter dropdown to choose filter options or;
    3. More Pages
      • Click 'Next' to see more forms, if needed, or; 
      • Use the lower right hand corner 'Per Page' dropdown to adjust how many forms you see at a time.

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