Brochure PDF: Health Plans for Oregon Large Groups2019 Oregon Large Group Plans

The information on this page is for large group plans beginning January 1, 2019.

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 (PDFs): 


Plan

Deductible

Out-of-pocket Maximum

Preventive Services
No deductible, member pays:

Office Visits 
After deductible, member pays:

SBCs (PDFs)
by Network
(
HSA rev. 11/27/18)
Summaries (PDFs)
by Network
500+20_20 $500 $3,500 Covered in Full $20* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
750+20_20 $750 $4,500 Covered in Full $20* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
1000+20_20 $1,000 $5,000  Covered in Full $20* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
1500+20_20 $1,500  $5,500  Covered in Full $20* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
1500+30_30 $1,500  $5,500  Covered in Full $30* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
2000+20_20 $2,000 $6,000  Covered in Full $20* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
2000+30_30 $2,000 $6,000 Covered in Full $30* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
2500+20_20  $2,500 $6,000 Covered in Full $20* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
2500+30_30  $2,500 $6,000 Covered in Full $30*  PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
3000+20_20 $3,000 $6,000 Covered in Full $20* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
3000+30_30 $3,000 $6,000  Covered in Full $30*  PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
3500+30_30 $3,500 $6,000  Covered in Full $30* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
4000+30_30 $4,000 $6,000 Covered in Full $30* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
5000+30_30 $5,000 $6,850 Covered in Full $30* PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
HSA 1500_20+Rx
Non-embedded
$1,500 $4,500 Covered in Full 20% PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
HSA 3000_50+Rx  $3,000 $6,350 Covered in Full 50% PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
HSA 3000+Rx $3,000 $3,000  Covered in Full Covered in Full PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
HSA 4000+Rx $4,000 $4,000 Covered in Full Covered in Full PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice
HSA 5000+Rx $5,000 $5,000  Covered in Full Covered in Full PacificSource / Legacy / SmartChoice PacificSource / Legacy / SmartChoice

 * Not subject to deductible.

 

Dental Plans (PDFs)

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 1000  
Dental Advantage Plus 20-20-50 1500  
Kids Dental Advantage 0-20-50 (rev. 02/12/19) Kids Dental Advantage 20-40-50 (rev. 02/12/19)
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 25-1500
Dental Advantage 0-20-50 1500 Dental Choice 0-20-50 50-1000
  Dental Choice 0-20-50 50-1500

 

Pharmacy Plans (PDFs, revised October 9, 2018)


OR 10-35-60 ODL OR 20P 1500D ODL OR 3000D ODL
OR 10-50P-50P ODL OR 50P ODL OR 4000D ODL
OR 5000D ODL

 

Vision Plans (PDFs)

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

 

Chiropractic Manipulation and Acupuncture (PDFs)

500 1500 2500
1000 2000

 

Brochures and Forms (PDFs)


Brochures:

Quote Request and Application Forms:

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

Brokers: You can now order sales kits for large group clients online!

Order printed materials today >  

  

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
  • Yamhill

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.