Oregon Medicare Advantage Plan Information

Oregon Health Insurance
Call 800.884.2343 or
541.434.9613
FAX - 541.284.2994

Medicare Supplement & Medicare Advantage Plan Information We would like to hear from you. Please provide us with some basic information and what you are interested in and we will furnish you with your information, or you may call us at (541) 434-9613 or (800) 884-2343. Please note that items in Bold Blue are required to submit the form. This is a solicitation for insurance. By providing this information, you agree that an authorized representative or licensed insurance agent/producer may coantact you by phone, email, or mail to answer questions or provide additional information about Medicare Advantage, Part D or Medicare Supplement Insurance plans.
Census Information -(More detail for more accurate quote)
Please list all individuals (you & your spouse) that you wish to cover.
Name	Date of Birth	Gender	Detail
		Male Female	Height: ft. in. Weight: lbs. Smoker? Yes No
		Male Female	Height: ft. in. Weight: lbs. Smoker? Yes No
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Medicare Advantage Plans		Medicare Supplement Plans

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