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) OMIP dependent application (.pdf fillable form) Automatic payment deduction request form (.pdf fillable form) Plan change request form (.pdf) Prescription claim form (.pdf) Status change form (.pdf) 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 \| Spring 2008 \| Summer 2008 \| Winter 2009 (.pdf) OMIP brochure (In English and Spanish) (.pdf) OMIP quickstart guide (.pdf) Health resources for you & your family (.pdf)


Enrollment statistics

OMIP Statistics Pack (.pdf)


Grievance or complaint

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

Page updated: March 31, 2009

Click here to go to the Oregon Dept. of Veterans' Affairs outreach contact form

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