Get Or 440-4978 2017

The OR 440-4978 form is critical for submission related to exchange certified pediatric dental insurance in Oregon. This guide provides a comprehensive walkthrough to help users complete the form accurately and efficiently.

Follow the steps to successfully complete and submit the OR 440-4978 form online.

1. Press the ‘Get Form’ button to acquire the OR 440-4978 form and open it in your preferred online editor.
2. Begin the form by entering the insurer's name at the top of the form. This information must be accurate and legible.
3. Input the date of the filing in the designated field. Ensure that the date reflects the actual submission date.
4. Select the appropriate Type of Insurance (TOI) code from the provided options, ensuring it aligns with your filing specifics.
5. Complete the Marketing section by indicating whether this is an Individual Health - Dental, Small Group, Group Health - Dental Stand Alone, or Embedded within medical forms.
6. Fill in the SERFF number related to your filing if applicable. This is crucial for tracking purposes.
7. Specify whether the form is for coverage 'Inside exchange only,' 'Outside exchange only,' or 'Both inside and outside exchange.'
8. For policies also covering adults, check that you submit the additional Form 440-3172A along with this form, if necessary.
9. Complete all required fields within the General Requirements and General Form Requirements sections, ensuring compliance with all indicated provisions.
10. Review your entries to prevent any omitted information or incomplete sections, as this will lead to disapproval of your filing.
11. Finalize the form by saving your changes. You may choose to download a copy, print it, or share it as required.

Complete your OR 440-4978 filing online today to ensure compliance with Oregon's pediatric dental insurance regulations.