Do you need to change beneficiaries? Add or remove dependents? Update payment information?
All forms can be electronically signed and emailed to our office. If you are sending in a paper form, please use:
Multnomah County Retiree Benefits Office
501 SE Hawthorne Blvd. Suite 320
Portland, OR 97214
Retiree Medical & Dental Plan Change Form:
- Retiree Medical & Dental Change Form (270 KB)
Other Required Forms:
- Affidavit of Marriage-Domestic Partnership (325.8 KB) - Required if adding a spouse/domestic partner
- EFT Authorization Form for Retiree Medical Dental Plan Costs (324.54 KB)
Life Insurance Beneficiary Change Forms:
- Life Insurance Beneficiary Form - $2,000 Plan (264.64 KB)
- Life Insurance Beneficiary Form - $5,000 Plan (300.72 KB)