Oregon Health Insurance-Independent Health Insurance Agents

Portland (503)231-6399  Toll Free (888)426-9544

Applications

 

 

 

These Applications are in Adobe pdf form.  Your computer should have it as one of its programs now.  If not you can use the yellow button and download it for free.

Regence BlueCross BlueShield of Oregon (OnLine)

 OnLine Application
Regence BlueCross BlueShield of Oregon (PDF) Download PDF application
Health Net Application  Health Net Outline
Kaiser Permanente Application   Kaiser Outline
Short Term On-Line Application
ODS Application     Apply for ODS Insurance Online ODS
PacifiCare Application PacifiCare
PacificSource Application PacificSource  On Line Application PacificSource Outline
Student plan ON-Line info- Application Student Outline
College Student Application 
Dental and Vision Application Dental and Vision
Dental Application Dental Outline

Regence BlueCross BlueShield of Oregon Medicare OnLine Applications

 Medicare 
LifeWise Health Plan of Oregon LifeWise OnLine Application

Privacy Statement- This request will be absolutely confidential.  The information will not be sold, given away or used for any other purpose but to mail or email requested information.

Information Request Form

This is not an application for insurance.  In the state of Oregon, Individual Health Insurance plans must be approved in the underwriting stage of the insurance application.  This might take a few weeks to complete.  Please leave your name address and questions and any information that you would like.

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Oregon Health Insurance-Independent Health Insurance Agents

Portland (503)231-6399  Toll Free (888)426-9544

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