Instructions
To apply using paper, for coverage in Clark County, Washington, follow the instructions below.
Or change your mind and apply online.
1. Click on the appropriate link below to open the form. Print the application and complete by hand.
Hints:
- Usually, you need to complete one application for yourself and one for each family member to be covered. Two or more family members can use the same application if enrolling on the same plan and if a parent is applying. If you are purchasing a plan for your child(ren) only (for instance, under Oregon YouthCare), you must fill out a separate application for each child.
- Select a plan and mark your selection on the application.
- Choose your deductible from the options provided.
- Initial to certify that your employer is not paying for your coverage.
- Answer all questions completely.
- Sign and date the application.
2. Complete the appropriate health questionnaire (required) below. One for each person applying.
3. Mail both forms to the address noted on the application:
Regence BlueCross BlueShield of Oregon
Attn: Individual Enrollment
Mail Station E-8U P.O. Box 1271
Portland, OR 97201-1271
If you prefer, you may drop the forms off at any of our regional offices.
