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

Individual Plans - Oregon

• Application
• Plan Change Form
• Plan Comparison
• Plan Rate Sheet
  • Q4 2009
• 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 (PDF)
• Disclosure and Policy Statement
• Plan Comparison
• Plan Rate Sheet
• Health Questionnaire (PDF)
• Blue Selections PPO Summary
• Regence Breakthru^SM 50 Summary
• Regence Breakthru^SM 70 Summary
  • English (PDF)
  • Spanish (PDF)
• Individual Dentacare Summary
• Regence HSA Healthplan Summary
  • English (PDF)
  • Spanish (PDF)
• Regence HSA Comprehensive Healthplan Summary
  • English (PDF)
  • Spanish (PDF)
• Frequently Asked Questions

Medicare Advantage (PPO) and Part D Prescription Plans

Regence MedAdvantage + Rx Enhanced (PPO), Regence MedAdvantage + Rx Classic (PPO) and Regence MedAdvantage (PPO)

• Enrollment Form
• 2009 (PDF)
• 2010
• Short Enrollment Form (for existing members to upgrade their plan)
  All pages of this form must be given to inquiring or applying individuals.
• 2009 (PDF)
• 2010
  

Medicare Script Enhanced (PDP) and Medicare Script (PDP)

• Enrollment Form
• 2009 (PDF)
• 2010
• Short Enrollment Form (for existing members to upgrade their plan)
  All pages of this form must be given to inquiring or applying individuals.
• 2009 (PDF)
• 2010

Medicare Companion (Medigap) Plans

View and print information for Oregon residents

• Application
• Brochure New for 2009
• Outline of Coverage New for 2009
• 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 New for 2009
• Brochure New for 2009
• Outline of Coverage New for 2009
• Notice to Applicant Regarding Replacement of Medicare Supplement Coverage
• Guide to Health Insurance for People with Medicare

• Durable Medical Equipment & Medical Supply Claim Form
• Prescription Medication Form
• Prescription Mail Order (PPS) Form

• Regence BCBSO SurePay Form
• BCBSO Affidavit of Domestic Partnership
• Scope of Appointment (Medicare Plans)

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