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2019-20 HB2557 Mid-Year Change Form - Use this form to request changes to your enrollments if you experience a Qualified Status Change event October 1, 2019 - September 30, 2020. For events prior to October 1, 2019, please call OEBB Member Services at 888-469-6322.
ACH Debit Authorization Form - Use this form to authorize payment if you are newly enrolling in coverage, or if you wish to change your bank account during the plan year.
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