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Division 053 Exhibits, appendixes, forms, attachments
836-053-0009Exhibit 1: SB 91 Oregon Standard Plans
836-053-0012Exhibit 1: Base benchmark health benefit planExhibit 2: Pediatric dental benefitsExhibit 3: Pediatric vision benefits
836-053-0013Exhibit 1: 2023 Bronze plan cost-sharing matrixExhibit 2: 2023 Silver plan cost-sharing matrix
836-053-0015Exhibit A: Revised Counting Methodology for Determining Small or Large Group
Exhibit B: Second Revised Counting Methodology for Determining Small or Large Group
836-053-0471Exhibit 1Exhibit 2Exhibit 3
836-053-0510 Oregon Standard Health Statement - Form 440-3087
836-053-0610Oregon Confidential Communication Request Form
836-053-0863 State Continuation Notice
836-053-1205 Uniform Prior Authorization Prescription Request -
836-053-1510(2)Primary Care Reporting TemplatePrimary Care Spending Reporting Template GuidelinesPrimary Care Spending Report list of codes for 2019 Report
836-053-1605Appendix A: Non-anesthesia reimbursement base rate
Oregon Revised Statutes Oregon Administrative Rules Oregon State Legislature
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