Please provide your client with all materials in each product section for a complete packet.

Individual Plans - Oregon

• Application
• Disclosure and Policy Statement
• Plan Change Form
• Plan Comparison
• Plan Rate Sheet - Q3 2008
• Blue Selections Premier Summary
• Blue Selections Plus Summary
• Blue Selections Basic Summary 
• Individual Dentacare Summary
• Regence HSA Healthplan Summary
• Notice of Privacy Practices
• Request to add a Newborn to your Individual Policy
• Certificate of Dependency Form

• Application
• Disclosure and Policy Statement
• Plan Comparison
• Plan Rate Sheet
• Standard Health Questionnaire for Washington State
• Blue Selections PPO Summary
• Regence Breakthru^SM 50 Summary
• Regence Breakthru^SM 70 Summary
• Regence Breakthru^SM 80 Summary
• Individual Dentacare Summary
• Regence HSA Healthplan Summary
• Regence HSA Comprehensive Healthplan Summary
• Frequently Asked Questions

Medicare Advantage and Part D Prescription Plans

• Regence MedAdvantage, Regence MedAdvantage + Rx and Regence MedAdvantage + Rx Enhanced
  • 2008 Enrollment Form
  • 2008 Short Enrollment Form (for existing members to upgrade their plan)
     
• Preferred Choice Sixty-Five
  • 2008 Enrollment Form
     
• Part D Prescription Drug Plan
  • 2008 Enrollment Form
  • 2008 Short Enrollment Form (for existing members to upgrade their plan)

Medicare Companion (Medigap) Plans

View and print information for Oregon residents

• Application
• Brochure
• Outline of Coverage
• Notice to Applicant Regarding Replacement of Medicare Supplement Coverage
• Guide to Health Insurance for People with Medicare

View and print information for Clark County, Washington residents

• Application
• Brochure
• Outline of Coverage
• Notice to Applicant Regarding Replacement of Medicare Supplement Coverage
• Guide to Health Insurance for People with Medicare

• Durable Medical Equipment Form (Regence Life & Health)
• Durable Medical Equipment & Medical Supply Claim Form
• Prescription Medication Form
• Direct Reimbursement Form
• Prescription Mail Order (PPS) Form
• Walgreens Prescription mail Order Form

• Individual Enrollment Plan Change Form
• Regence BCBSO SurePay Form
• BCBSO Affidavit of Domestic Partnership

Note: To print a PDF document, you need Adobe® Acrobat® Reader. Download it now for free.