2017 Oregon Large Group Plans

The information on this page is for large group plans beginning January 1 and April 1, 2017.  

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

Co-pay for office visits

Co-insurance 
after deductible

SBCs
effective January 1

by Network
SBCs
effective April 1

by Network
Summaries
by Network
500+20_20 $500 $3,500 $20 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
750+20_20 $750 $4,500 $20 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
1000+20_20 $1,000 $5,000  $20 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
1500+20_20 $1,500  $5,500  $20 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
1500+30_30 $1,500  $5,500  $30 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy  
2000+20_20 $2,000 $6,000  $20 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
2000+30_30 $2,000 $6,000 $30  30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
2500+20_20  $2,500 $6,000 $20 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy  PacificSource / SmartChoice / Legacy
2500+30_30  $2,500 $6,000 $30 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
3000+20_20 $3,000 $6,000 $20 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
3000+30_30 $3,000 $6,000  $30  30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
3500+30_30 $3,500 $6,000  $30 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
4000+30_30 $4,000 $6,000 $30 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
5000+30_30 $5,000 $6,850 $30 30% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 1500_20+Rx
Non-embedded
$1,500 $4,500 No co-pay 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 3000+50+Rx  $3,000 $6,350 No co-pay 50% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 3000+Rx $3,000 $3,000  No co-pay No charge after deductible PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 4000+Rx $4,000 $4,000 No co-pay No charge after deductible PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
HSA 5000+Rx $5,000 $5,000  No co-pay No charge after deductible PacificSource / SmartChoice / Legacy 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 25-1500
Dental Advantage Plus 0/20/50 25-1000 Dental Choice Plus 0/20/50 50-1000
Dental Advantage Plus 0/20/50 25-1500 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. For information and requirements, please see our Voluntary Dental flier.

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

 

Pharmacy Plans


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

 

Chiropractic Manipulation and Acupuncture

 500 1000 1500 2000 2500

 

Vision Plans

 OR_10-150 Vision Plus
 OR_10-300 Vision Exam Only

 

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.