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Benefit Forms
Enrollment Forms
Health Coverage (Medical, Dental, & Vision)
PEBB Enrollment Form
(.pdf file)
PEBB Affidavit of Domestic Partnership
(.pdf file)
Life and Disability
PEBB Life and Disability
(.pdf file)
Standard Medical History Statement
(.pdf file)
Standard Medical History Statement Online
Flexible Spending Account
Dependent Care
(.pdf file)
Health Care
(.pdf file)
Long Term Care
Update Forms
Health Coverage (Medical, Dental & Vision)
PEBB Update Form
(.pdf file)
PEBB Affidavit of Dependency
(.pdf file)
PEBB Termination of Domestic Partnership
(.pdf file)
Life and Disability
Life and Disability
(.pdf file)
Flexible Spending Account
Dependent and Health Care
(.pdf file)
Beneficiary Designation
PEBB (Life and Disability)
(.pdf file)
PERS Tier One/Tier Two (retirement)
(.pdf file)
PERS IAP (retirement)
(.pdf file)
Reimbursement Forms
Regence BCBSO Form (claims, Rx, Rx mail order, etc.)
(.pdf file)
Dependent Care and Healthcare Flexible Spending Account Claim Form
(.pdf file)
VSP Reimbursement Form
(.pdf file)
Samaritan Select - Mail Order Pharmacy
Staff Free Privileges
Enrollment Form
(.pdf file)
Tax Deferred Investment and Savings Plan
Tax Deferred Investment (403b) Salary Reduction Agreement
(.pdf file)
Oregon Savings Growth Plan (457) Forms
Workers' Compensation Forms
Important Information for Employees with Occupational Injuries
(.pdf file)
SAIF Claim Form 801
(.pdf file)
Instructions for Completing the 801
(.pdf file)
OSU Report of Accident
(.pdf file)
Employee Status Report
(.doc file)
Continued Benefits for Injured Workers Notice
(.pdf file)
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