Sample Plan Summaries for Oregon
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.
Sample summary of benefits and coverage (SBC) documents are now available for Oregon Preferred medical plans.
Group Medical Plans
Plan Limitations effective August 1, 2012
Preventive Care Limits for Preferred, Prime, and Choice
Preferred CoDeduct Plans
Effective August 1, 2012:
Preferred CoDeduct Value Plans
Effective August 1, 2012:
$300 and $500 deductible plans available for small groups only.
Preferred CoPay Plans
Effective August 1, 2012:
Preferred HSA Plans
Effective August 1, 2012:
Preferred Basic Health Plan (BHP)
Effective August 1, 2012:
Prime Plans
Effective August 1, 2012:
Choice Plans
Effective August 1, 2012:
Optional Benefits
Prescription Drug Plans
Dental Plans
Effective July 1, 2011:
Available on a stand-alone basis for groups with 2 to 9 enrolled employees
Dental Coverage Options (For small groups with 2-50 eligible employees)
Vision Plans
Effective August 1, 2012:
Alternative Care and Chiropractic Care Plans
Life and Disability Plans
| $10,000 |
$10,000 with dependent option |
| $20,000 |
$20,000 with dependent option |
| $30,000 |
$30,000 with dependent option |
| $40,000 |
$40,000 with dependent option |
| $50,000 |
$50,000 with dependent option |
Other Optional Benefits