Office of Private Health Partnerships Publications & Forms

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Office of Private Health Partnerships

Department

Publications & Forms

Applicant & Member

Office of Private Health Partnerships (OPHP)


Applicant & Member

FHIAP brochure: English \| Spanish \| Vietnamese \| Russian (.pdf) FHIAP program summary (.pdf) Member guide (.pdf) Member Connections newsletter: Fall 2006 \| Winter 2007 \| Spring 2007 \| Summer 2007 \| Fall 2007 \| Winter 2008 \| Spring 2008 \| Summer 2008 Subsidy income guideline chart (.pdf) 2009 FHIAP billing calendar (.pdf) FHIAP "roadmap" to individual insurance (.pdf) Enrollment verification form (fillable .pdf) Applicant consent form (fillable .pdf) Request to end FHIAP subsidy (Word fillable .doc) Request to end OHP medical benefits (Word fillable .doc) Direct deposit and change of address information Add dependent form: Word fillable .doc or .pdf Citizenship requirement (.pdf) Citizenship requirement (Spanish version) (.pdf)


Producer

Producer Connections newsletter: Winter 2007 (Published March 2007) Spring 2007 (Published June 2007) Fall 2007 (Published October 2007) Winter 2008 (Published January 2008) Spring 2008 (Published March 2008) Summer 2008 (Published July 2008) Producer referral program application (.pdf) Applicant consent form (fillable .pdf) FHIAP benchmark for group health insurance (.pdf) Request for benchmark analysis form (.pdf) FHIAP approved individual market insurance companies and plans FHIAP "roadmap" to individual insurance (.pdf) Premium savings with FHIAP (Word fillable with calculations .doc) \| Sample and explanation (.pdf)


Employer

Employer guide (.pdf) Group insurance information form (.pdf) From www.OregonRX.org: Controlling prescription drug costs - THE TOOL KIT (.pdf) Payroll stuffer Side 1 (.pdf) \| Side 2 (.pdf) Enrollment verification form (fillable .pdf) Premium savings with FHIAP (Word fillable with calculations .doc) \| Sample and explanation (.pdf)


Office of Private Health Partnerships (OPHP)

Health resources for you & your family (.pdf) Analysis of state-designed small employer health plans (.pdf) Ways & Means presentation April 8, 2009 (.pdf) Ways & Means presentation slides April 8, 2009 (.pdf)

Page updated: May 13, 2009

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