Sample Plan Summaries en Español
The sample summaries and plan limitations 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.
Group Medical Plans
Plan Limitations for plans effective August 1, 2012
Preventive Care Limits for Preferred, Prime, and Choice
Preferred CoDeduct Plans
Effective August 1, 2012:
Effective July 1, 2011:
Preferred CoDeduct Value Plans
Effective August 1, 2012:
$300 and $500 deductible plans available for small groups only.
Note: A few plans will be updated effective January 1, 2012. Those plans are:
Effective July 1, 2011:
$300 and $500 deductible plans available for small groups only.
$25 copay plans available for large groups only.
Preferred Deductible and Percentage Plans
Beginning August 1, we will no longer offer Preferred Deductible and Preferred Percentage plans.
Preferred CoPay Plans
Preferred HSA Plans
Preferred Basic Health Plan (BHP)
Effective August 1, 2012:
Effective July 1, 2011:
Prime Plans
Effective August 1, 2012:
Effective July 1, 2011:
Choice Plans
Optional Benefits
Prescription Drug Plans
Effective December 1, 2012:
Dental Plans
Available on a stand-alone basis for groups with 2 to 9 enrolled employees
Vision Plans
Effective August 1, 2012:
Effective prior to August 2012:
Alternative Care and Chiropractic Care Plans
Other Optional Benefits