Get Oregon Renewal Confirmation - Pacificsource

Completing the Oregon RENEWAL CONFIRMATION form for PacificSource is an essential step in maintaining your employee benefits. This guide provides clear instructions to help users navigate each section of the form effectively and accurately.

Follow the steps to fill out the Oregon renewal confirmation form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Enter the employer information. Fill in the Group Name and Group Number. Make sure to provide the Renewal Date along with the Eligibility Contact and Billing Contact names, ensuring you indicate any changes or confirm they are unchanged.
3. Detail the eligibility requirements. Select a probationary period from the provided options and specify if the coverage takes effect on the same day or the first day of the following month. Enter the minimum required hours for eligibility.
4. Indicate the employer contributions for employee and dependent coverage, and specify if your group has a Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA).
5. List and confirm the names of all owners and partners involved in the coverage. This section is crucial for transparency and regulatory compliance.
6. Provide detailed benefit information, including the plan names for Medical, Dental, and any other coverage. Ensure they match what is noted on your renewal notice.
7. Review the document distribution preferences. Choose if you want an electronic copy, hardcopy, or both. Confirm you understand the important information related to the Affordable Care Act that pertains to your group.
8. Finally, read the signature section carefully, understanding and agreeing to the terms listed. Sign, date, and note your title before submitting.
9. Once completed, you can save your changes, download a copy, or share the form as necessary.

Ensure your renewal form is completed and submitted online before the deadline.