Enrollment forms:
- RR New Enrollment DSA-CD (200.32 KB)
- RR New Enrollment 88-86-22-884-99 (199.24 KB)
- RR New Enrollment 38-223-701 (201.59 KB)
- RR Enrollment Deferral (74.31 KB) due to enrollment in other Multnomah County employee/retiree coverage
If Medicare-eligible at retirement:
Any member being enrolled in Retiree medical coverage is required to enroll in Medicare, if eligible. If enrolling in Multnomah County-sponsored Kaiser medical, please contact 503-988-5651 to request a separate Kaiser Senior Advantage application.
- CMS Medicare Employment Verification Medicare Request for Employment Information (66.5 KB)
- CMS Medicare Part B Application Medicare Part B Application (69.13 KB)
Premium Payments:
- RR Prem Payment Method Election (38.02 KB)
- EFT Authorization Form for Retiree Medical Dental Plan Costs (324.54 KB)
Retiree Life Insurance:
- Life Insurance Beneficiary Form - $2,000 Plan (264.64 KB)
- Life Insurance Beneficiary Form - $5,000 Plan (300.72 KB)