SMG72_080918_Oregon_Medical_SmallGroup_cover2019 Oregon Small Group Plans 

The information on this page is for small group plans beginning January 1, 2019. Small groups in Oregon are employers with one to 50 employees.

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 chart below. Plans are available direct with PacificSource and through OregonHealthcare.gov, unless otherwise noted.

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
Summaries (PDFs)
by Network
Gold 1000^ $1,000 $5,500 Covered in Full Primary/Urgent Care: $20 co-pay*
Specialist: $50 co-pay*
PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
Gold 2000^ $2,000 $5,500 Covered in Full Primary/Urgent Care: $20 co-pay*
Specialist: $50 co-pay*
PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
Silver 3500^ $3,500 $7,350  Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartChoice / Legacy (Rev. 12/3/18) PacificSource / SmartChoice / Legacy
Silver 4000^  $4,000 $7,350 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
Silver 5000^  $5,000 $7,350 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
Bronze 7600 $7,600 $7,600  Covered in Full Primary/Urgent Care: $35 co-pay*
Specialist: Covered in Full
PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
Gold HSA 3000 $3,000 $3,000  Covered in Full Covered in Full PacificSource / SmartChoice / Legacy
(Rev. 4/1/19)
PacificSource / SmartChoice / Legacy
(Rev. 4/1/19)
Silver HSA 3000 $3,000 $6,650  Covered in Full 20% PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
Silver HSA 4000 $4,000 $4,000  Covered in Full Covered in Full PacificSource / SmartChoice / Legacy
(
Rev. 12/27/18)
PacificSource / SmartChoice / Legacy
Silver HSA 5400 $5,400 $5,400  Covered in Full Covered in Full PacificSource / SmartChoice / Legacy
(
Rev. 12/27/18)
PacificSource / SmartChoice / Legacy
Bronze HSA 5200 $5,200 $6,650  Covered in Full 50% PacificSource / SmartChoice / Legacy
(
Rev. 12/27/18)
PacificSource / SmartChoice / Legacy
Bronze HSA 6650 $6,650 $6,650  Covered in Full Covered in Full PacificSource / SmartChoice / Legacy PacificSource / SmartChoice / Legacy
Standard Gold** $1,000 $6,850 Covered in Full Primary: $20 co-pay*
Urgent Care: $60 co-pay*
Specialist: $40 co-pay
PacificSource PacificSource
Standard Silver**  $2,850 $7,900 Covered in Full Primary: $40 co-pay*
Urgent Care: $70 co-pay*
Specialist: $80 co-pay*
PacificSource PacificSource
Standard Bronze**  $6,550  $6,550  Covered in Full Covered in Full PacificSource PacificSource

^Adult vision included on this plan.
*Not subject to deductible. 

**Only available on the PacificSource network.

 

Dental Plans

Dental handbook samples (PDFs): 

Summaries (PDFs): 

Dental Choice 0-20-50 50-1000^    
Dental Choice Plus 0-20-50 25-1000 Dental Choice Plus 0-20-50 50-1000
Dental Choice Plus 0-20-50 25-1500 Dental Choice Plus 0-20-50 50-1500
Dental Advantage Core  
Dental Advantage 0-20-50 1000 Dental Advantage 0-20-50 1500
Dental Advantage 20-20-50 1000 Dental Advantage 20-20-50 1500
Dental Advantage Plus 0-20-50 1000 Dental Advantage Plus 0-20-50 1500
Kids Dental Advantage 0-20-50 Kids Dental Advantage 20-40-50
Dental Advantage Essentials Dental Advantage Essentials Plus
Ortho 1000 WP^*  

^ Available direct from PacificSource only.

* Additional eligibility requirements may apply.

 

Brochures and Forms 


Brochures (PDFs):  

Quote Request and Enrollment Forms (PDFs): 

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

 

Choose a Medical Plan in One of Three Networks


Access more providers with our PacificSource Network.

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 your employees will have more providers to choose from.

PacificSource Network Availability

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

 

Lower your costs with our SmartChoice and Legacy Health networks.

The SmartChoice and Legacy Health Networks are designed to give your employees a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care for your employees at a lower cost.

SmartChoice Network Availability

If your business is in one of the following counties, you can choose plans on the SmartChoice Network:

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

Legacy Health Network Availability

If your business is in one of the following counties, you can choose plans on the Legacy Health Network:

  • Clackamas
  • Multnomah
  • Washington
  • Yamhill