Get Oregon Standardized Group Profile Form - Pacificsource.com

Filling out the Oregon Standardized Group Profile Form is an essential step for groups seeking health benefit plans in Oregon. This guide provides clear instructions to navigate the form's sections effectively.

Follow the steps to complete the Oregon Standardized Group Profile Form.

1. Press the ‘Get Form’ button to acquire the Oregon Standardized Group Profile Form and open it in your online editor.
2. Begin with Section A. Here, you need to input your company name, group number if applicable, physical address, state of headquarters, and company type (e.g., LLC, sole proprietor, S-corp). Provide the contact name, title, email address, telephone number, and information about your producer and their telephone number.
3. Proceed to Section B. The initial question assesses whether a majority of your employees were employed in Oregon during the preceding calendar year. Select 'Yes' or 'No' and follow the logic as directed.
4. Continue answering questions regarding the average number of employees you employed during the previous calendar year, expectations for the current year, and whether coverage is provided to individuals not categorized as eligible employees.
5. In Section B, question 5, enter the number of eligible employees expected on the effective date of coverage. Follow through the provided options to determine if your group qualifies as small or large.
6. Move to Section C. Certify that all the information provided is accurate. Sign and date the document, include your name, title, and confirm your role in the organization (e.g., owner, group administrator, etc.). Indicate the purpose of the form (quote or renewal).
7. Once you have filled out all sections and verified the information for accuracy, you can save the changes, download, print, or share the form as needed.

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