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This document serves as a guide for administrative staff on how to fill out the OEBB MODA Enrollment Form. It provides instructions on entering personal information, selecting medical, vision, and dental plans, and outlines the requirements for opting out of OEBB medical coverage. The document also includes details on life insurance, disability coverage, and the enrollment process for employees and their dependents.

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How to fill out oebb moda enrollment form

01

Obtain the OEPP Moda enrollment form from the official website or your employer.

02

Fill in your personal information, including your full name, address, date of birth, and contact details.

03

Provide information about your employment status and your employer's details.

04

Include any required information about dependents you wish to enroll.

05

Choose your desired health plan options offered under OEPP Moda.

06

Review the form for accuracy and completeness.

07

Sign and date the form to confirm your enrollment.

08

Submit the completed form via the specified method (online, mail, or fax) as instructed.

Who needs oebb moda enrollment form?

01

Individuals applying for health insurance coverage through OEPP Moda.

02

Employees of companies that offer OEPP Moda as a health insurance option.

03

Dependents of employees who wish to be covered under the same health insurance plan.

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What is oebb moda enrollment form?

The OEBB MODA enrollment form is a document used by individuals to enroll in the Oregon Educators Benefit Board health insurance plans, specifically for the MODA Health insurance options.

Who is required to file oebb moda enrollment form?

Employees of Oregon public education institutions who wish to enroll themselves and their eligible dependents in the OEBB health insurance plans are required to file the OEBB MODA enrollment form.

How to fill out oebb moda enrollment form?

To fill out the OEBB MODA enrollment form, individuals need to provide personal information, select their desired insurance plan, list dependent information if applicable, and sign the form to certify accuracy.

What is the purpose of oebb moda enrollment form?

The purpose of the OEBB MODA enrollment form is to facilitate the enrollment process for eligible employees and their dependents in the OEBB health insurance plans offered by MODA.

What information must be reported on oebb moda enrollment form?

The form must report personal details such as the employee's name, address, Social Security number, plan selection, and information about dependents to be covered.

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