Brochure PDF: Health Plans for Oregon Large Groups2018 Oregon Large Group Plans

The information on this page is for large group plans beginning January 1, 2018.

Medical Plans

Deductible and out-of-pocket limit amounts shown below are the costs for individuals. Amounts for families are twice the individual amounts. If members receive services from out-of-network providers, their deductible and out-of-pocket limit will be higher than the amounts listed in the table below. 

Medical handbook samples: 


Plan

Deductible

Out-of-pocket limit

Office visits 
Services performed during
an office visit may be
billed separately.

Co-insurance

SBCs
by Network
Summaries
by Network
500+20_20 $500 $3,500 $20 co-pay After deductible, 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
750+20_20 $750 $4,500 $20 co-pay After deductible, 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
1000+20_20 $1,000 $5,000  $20 co-pay After deductible, 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
1500+20_20 $1,500  $5,500  $20 co-pay After deductible, 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
1500+30_30 $1,500  $5,500  $30 co-pay After deductible, 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy  
2000+20_20 $2,000 $6,000  $20 co-pay After deductible, 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
2000+30_30 $2,000 $6,000 $30 co-pay  After deductible, 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
2500+20_20  $2,500 $6,000 $20 co-pay After deductible, 20% PacificSource / SmartChoice / Legacy   PacificSource / SmartChoice / Legacy
2500+30_30  $2,500 $6,000 $30 co-pay After deductible, 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
3000+20_20 $3,000 $6,000 $20 co-pay After deductible, 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
3000+30_30 $3,000 $6,000  $30 co-pay  After deductible, 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
3500+30_30 $3,500 $6,000  $30 co-pay After deductible, 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
4000+30_30 $4,000 $6,000 $30 co-pay After deductible, 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
5000+30_30 $5,000 $6,850 $30 co-pay After deductible, 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 1500_20+Rx
Non-embedded
$1,500 $4,500 After deductible, 20% After deductible, 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 3000_50+Rx  $3,000 $6,350 After deductible, 50% After deductible, 50% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 3000+Rx $3,000 $3,000  After deductible, covered in full After deductible, covered in full PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 4000+Rx $4,000 $4,000 After deductible, covered in full After deductible, covered in full PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 5000+Rx $5,000 $5,000  After deductible, covered in full After deductible, covered in full PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy

 

Dental Plans

Dental handbook samples:


Dental Advantage Essentials Dental Choice Plus 0-20-50 25-1000
Dental Advantage Essentials Plus Dental Choice Plus 0-20-50 50-1000
Dental Advantage Plus 0-20-50 1000 Dental Choice Plus 0-20-50 25-1500
Dental Advantage Plus 0-20-50 1500 Dental Choice Plus 0-20-50 50-1500
Dental Advantage Plus 0-20-50 50-1000 Dental Choice Plus 20-20-50 50-1000
Dental Advantage Plus 0-20-50 50-1500 Dental Choice Plus 20-20-50 50-1500
Dental Advantage Plus 20-20-50 50-1000  
Dental Advantage Plus 20-20-50 50-1500  
Kids Dental Advantage 0-20-50 Kids Dental Advantage 20-40-50
Orthodontia 1000 Orthodontia 1500

Voluntary Dental Option Plans

Our Voluntary Dental option is available to businesses with ten or more enrolled employees. 

Dental Advantage 0-20-50 1000 Dental Choice 0-20-50 50-1000
Dental Advantage 0-20-50 1500 Dental Choice 0-20-50 25-1500
  Dental Choice 0-20-50 50-1500

 

Pharmacy Plans


OR 10-35-60 ODL OR 20P ODL OR 3000D ODL
OR 10-50P-50P ODL OR 50P ODL OR 4000D ODL
    OR 5000D ODL

 

Chiropractic Manipulation and Acupuncture

  500 1000 1500 2000 2500

 

Vision Plans

  Vision 10-150 Vision Plus
  Vision 10-300 Vision Exam Only

 

Brochures and Forms


Quote Request and Application Forms:

Visit our Oregon Forms and Materials page for more sales materials.

 

Network Availability (Medical)


Network availability varies depending on geographic location. 

PacificSource Network (PSN)

 

Availability: All Oregon businesses can choose health plans on the PacificSource Network, regardless of location.

Notable features: The PacificSource Network (PSN) includes the broadest access to in-network providers and facilities, such as hospitals and urgent care centers. Plans on the PacificSource Network will typically cost more because members will have more providers to choose from.

 

SmartChoice Network

 

Availability: Businesses located in the following counties can choose plans on the SmartChoice Network: 

  • Benton
  • Coos
  • Crook
  • Curry
  • Deschutes
 
  • Douglas
  • Jackson
  • Jefferson
  • Josephine
  • Lane
 
  • Linn
  • Marion
  • Polk
 

Notable features: The SmartChoice Network is designed to give members a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care for members at a lower cost.

 

Legacy Health Network

 

Availability: Businesses located in the following counties can choose plans on the Legacy Health Network:

  • Clackamas
  • Multnomah
  • Washington

Notable features: The Legacy Health Network is designed to give members a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care for members at a lower cost.