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2020-21 Enrollment Materials

2019-20 Enrollment Materials


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.

Note: If you are continuing coverage from 2019-20 and wish to continue using the same bank account, you do not need to submit another ACH Debit Authorization Form. Your previous authorization will automatically continue.

HB2557 Frequently Asked Questions

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