Oregon Medical Insurance Pool Forms & Publications

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Oregon Medical Insurance Pool

Department

Forms & Publications

Enrollment statistics

Grievance or complaint


Forms

OMIP application (.pdf fillable form) Updated November 2007 OMIP dependent application (.pdf fillable form) NEW November 2007 Automatic payment deduction request form (.pdf) Plan change request form (.pdf) Updated December 2007 Prescription claim form (.pdf) Status change form (.pdf) Updated November 2007 Use this form to add or drop a dependent, change your address, or request a new identification card.


Publications

OMIP newsletters: Spring 2006 \| Fall 2006 \| Spring 2007 \| Fall 2007 (.pdf) OMIP brochure (In English and Spanish) (.pdf) Updated October 2007 Help with OMIP premiums (.pdf) NEW If you are applying for OMIP coverage, you may qualify to receive assistance regarding your monthly OMIP premiums from the Family Health Insurance Assistance Program (FHIAP). OMIP quickstart guide (.pdf) NEW


Enrollment statistics

OMIP Statistics Pack (.pdf)


Grievance or complaint

To file a grievance or complaint contact customer service at (800) 848-7280.

Page updated: December 05, 2007

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