Sample Plan Summaries for Idaho

The sample summaries below are approved PacificSource employer plan designs. At enrollment, members receive customized benefit books showing their specific benefits, lifetime maximums, and any optional coverage provided by the employer. For group-specific member benefit summaries, or previously offered summaries, contact your regional PacificSource office.

If you would like an older summary, please contact your Sales Representative.

Small Group Plans

Preferred Deductible and Percentage plans effective January 1, 2012:

50+3000
50+5000

Large Group Plans

Preferred Deductible and Percentage plans effective January 1, 2012:

50+3000
50+5000

Optional Benefits

Indemnity Plans	Dental Advantage Premier (PPO)	Dental Advantage (PPO)
Preventive $25/$1,000	80/80/80/50 25/1000	80/80/50/50 25/1000
Preventive $50/$1,000	80/80/80/50 25/1500	80/80/50/50 25/1500
Preventive $25/$1,500	80/80/80/50 25/2000	80/80/50/50 25/2000
Preventive $50/$1,500	80/80/80/50 50/1000	80/80/50/50 50/1000
Comp $25/$1,000	80/80/80/50 50/1500	80/80/50/50 50/1500
Comp $50/$1,000	80/80/80/50 50/2000	80/80/50/50 50/2000
Comp $25/$1,500	100/80/80/50 25/1000	100/80/50/50 25/1000
Comp $50/$1,500	100/80/80/50 25/1500	100/80/50/50 25/1500
Orthodontia	100/80/80/50 25/2000	100/80/50/50 25/2000
	100/80/80/50 50/1000	100/80/50/50 50/1000
	100/80/80/50 50/1500	100/80/50/50 50/1500
	100/80/80/50 50/2000	100/80/50/50 50/2000

Available on a stand-alone basis for groups with 2 to 9 enrolled employees