Forms

Update Forms

• PEBB Medical/Dental Update Form
• PEBB Life/Disability Update Form
• PEBB Healthcare/Dependent Care Flexible Spending Account Update Form
• PEBB Designation of Beneficiary Update Form

Enrollment Forms

• PEBB (OUS) Medical/Dental Enrollment Form
• PEBB Life/Disability Enrollment Form
• PEBB Healthcare/Dependent Care Flexible Spending Account Enrollment Form

Reimbursement Forms

• Regence BCBSO Medical/Prescription Reimbursement Form
• Mail Order Pharmacy - Postal Prescription Services (PPS)
• VSP Out-Of-Network Reimbursement Form
  
  
• Healthcare and Dependent Care Flexible Spending Account Reimbursement Form - ASIFlex website
  • Fillable PDF form
  • Word Document

Retirement Plan Forms

• Tax-Deferred Investment Plan (403b) Salary Reduction Agreement
• Oregon Savings Growth Plan Forms
• PERS Designation of Beneficiary Form
• IAP Designation of Beneficiary Form
• PERS One-Time Variable Election Form
• PERS Retirement Application with Instructions
• IAP Retirement Application with Instructions
• PERS Estimate Request Form

Other Forms

• Domestic Partner Affidavit
• Termination of Domestic Partnership Form (you also need to complete the PEBB Medical/Dental Update Form)
• PEBB Appeal Form
• Affidavit of Dependency
• Standard Life Insurance Portability Form
• Roll Over of Life Insurance
• Medical History Statement for Optional Life Insurance (paper form)
• Medical History Statement for Optional Life Insurance (complete and submit online)

Retiree Benefit Forms

• Benefit Estimate Request Form
• PEBB 2009 Retiree Insurance Medical/Dental Enrollment Form (non-Medicare eligible)
• PEBB Retiree Life Insurance Application
• PERS Health Insurance Intent/Enrollment Form