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<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">ATTENTION: Self-Pay Retiree Forms Update<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">If your entity has OEBB administer the Self-Pay Early Retiree enrollments please be aware the forms you provide to your retirees have been updated. Make sure you are providing
them the most current ACH Debit Authorization form and Self-Pay Early Retiree Enrollment form. If you have old forms, please discard them and print the latest version here:
<a href="http://www.oregon.gov/oha/OEBB/Pages/Self-Pay-Early-Retirees.aspx"><span style="color:#0563C1">http://www.oregon.gov/oha/OEBB/Pages/Self-Pay-Early-Retirees.aspx</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">I have also included the forms as an attachment to this email. If the retiree submits an outdated ACH Debit Authorization form, it will be returned and they will be asked to
submit the current version.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Please contact me If you have any questions relating to Self-Pay Retirees.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif">Thank you,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black">Dawn Wrezinski<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black">Senior Benefits Analyst</span><span style="font-size:12.0pt;color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black">OREGON HEALTH AUTHORITY<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black">Health Policy and Analytics<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black">Oregon Educators Benefit Board</span><span style="font-size:12.0pt;color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><u><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black"><a href="mailto:OEBB.Benefits@state.or.us"><span style="color:#0563C1">OEBB.Benefits@state.or.us</span></a><o:p></o:p></span></u></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:black">Phone: 888.469.6322<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#232323"><a href="http://www.OEBBinfo.com"><span style="color:#0563C1">www.OEBBinfo.com</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#232323"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#232323"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#44546A"><img border="0" width="159" height="60" id="Picture_x0020_1" src="cid:image001.jpg@01D2EAA7.E5FF5680" alt="cid:image001.jpg@01D10D96.C6B9DCE0"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#44546A"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif;color:#44546A">CONFIDENTIALITY NOTICE</span><span style="font-size:14.0pt;font-family:"Arial",sans-serif;color:#44546A"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif;color:#44546A">This email may contain information that is privileged, confidential, or otherwise exempt from disclosure under applicable law. If you are not the addressee or it appears from the
context or otherwise that you have received this email in error, please advise me immediately by reply email, keep the contents confidential, and immediately delete the message and any attachments from your system.
<o:p></o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
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