Enrollment

Agent Responsibility

Provide the following information no later than the 20th of the month for a first of the following months effective date.

Premium: One month premium for coverage.
Group Application: A completed group medical and/or dental application that is signed by both the group and agent.

Enrollment/Declination Forms: Submit either a completed enrollment or waiver form for each eligible employee.

Group Size 2-4

Group Size 5-99

Group Size 100+

Affidavit of Domestic Partnership

Declination of coverage

Oregon Continuation of Coverage

ODS will provide the following information to you:

Member Guides: Guide provided to members regarding how their plan works, choosing a primary care physician, referral to specialists, mental health and chemical dependency, and urgent care.
Benefit Summaries
Enrollment Form: Member enrollment application and change of information form. If a member is enrolling in a Managed Care or Point of Service medical plan, be sure each member lists a primary care physician, from the participating professional directory or from this website, on the enrollment form. Each insured family member may select a different PCP; however, all family members must select PCP(s) from the same participating professional directory. Note: All eligible individuals waiving coverage must complete a declination of coverage form. Please refer to the Eligibility and Enrollment Guidelines located in the Forms Section.
Prescription Drug Claim Form (medical only): Members, who purchase prescriptions at a pharmacy prior to receiving an ID card, will need to file a claim form for reimbursement. (Please allow three weeks for ODS to enroll a new member.) Members should pay for their prescription(s) in full, complete a prescription reimbursement form and mail it to ODS Heath Plans. Members will be reimbursed at the same rate (minus the copayment, if any) that ODS would have reimbursed a participating pharmacy in the ODS Pharmacy Network.
Mail Service Prescription Program (medical only): Mail Service Prescription Drug Order Form.