Appeals

Appeals Process

OEBB provides a process for members to request a formal review of an eligibility, enrollment or coverage issue. If you would like to request such a review, please first read the OEBB Appeal, Reconsideration and Administrative Review Policy and Procedures.

Once you have read the policy and procedures document above, if you would like to proceed with filing a request, you may do so using this form:

• Appeal Form (Adobe PDF format) - Print this blank form, complete all information by hand, SIGN THE COMPLETED FORM, then mail or fax to OEBB.