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. This process is important. We are working diligently to train staff to make this happen for you quickly. As we make forms fillable, they will be identified in the description column.

Click Title link of the form needed.
Download the form to your computer.
Be sure to fill in all Required Fields.
Be sure to Save your PDF! (We encourage you to keep a copy for your records.)
The last page of each form has information about where and how 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.

Still can't find it? Check the DHS/OHA Publications Library

Form page Instructions:

Search

Enter keywords in the Search box, (example: mid-year change, divorce, affidavit, enrollment, fsa, etc.)

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.

Filter

Click Filter dropdown to choose filter options or;

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.