Get Oregon Group Profile Form

The Oregon Group Profile Form is essential for determining whether your group qualifies as a small employer for health insurance coverage. This guide will provide you with step-by-step instructions on how to successfully complete the form online, ensuring a smooth application process.

Follow the steps to fill out the Oregon Group Profile Form online.

1. Click ‘Get Form’ button to obtain the Oregon Group Profile Form and open it in your online editor.
2. Complete Section A: Enter the company name, address, company headquarters, contact name, and producer name as accurately as possible.
3. Move to Section B: Input the average number of employees during the preceding calendar year. If applicable, answer whether more than 50 percent of those employees worked in Oregon.
4. Indicate the number of eligible employees as of the date coverage is to take effect, ensuring to include only those who work a regular schedule of 17.5 hours or more per week.
5. Review Section C: Read the disclosure notice carefully, as it outlines conditions that may classify your group as a small or large employer based on your average number of employees.
6. Certify the information: To the best of your knowledge, confirm that all information provided is correct by signing the form. Include your title and the date.
7. Once the form is completed, save any changes, and use the options to download, print, or share the completed Oregon Group Profile Form.

Complete your Oregon Group Profile Form online today to ensure your group is properly classified.