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Sample Plan Summaries for Oregon

The sample summaries available here represent our approved Oregon small employer plan designs. Upon enrollment, members receive customized summaries showing their specific benefits, lifetime maximums, and any optional coverage provided by the employer. For group-specific member benefit summaries, please contact the PacificSource office in your area:

Portland: (503) 699-6561
Bend: (541) 330-8896 or (888) 877-7996

Medford: (541) 858-0381 or (800) 899-5866
Eugene: (541) 687-7047 or (877) 657-9797

Boise: (208) 342-3709 or (888) 492-2875 - view Idaho plan summaries

Spanish language plan benefit summaries are available here.

MEDICAL PLANS
Summary of group medical plan limitations/exclusions

Preferred CoDeduct Plans:
300+15 1000+15 2000+35
300+25 1000+25 2000+35/70% 
500+15 1000+35 2000+50
500+25 1000+50 2500+25
500+35 1500+25  2500+35
750+15 1500+35 2500+50
750+25 1500+50 3000+35/70%
750+35 2000+25

NEW! Preferred CoDeduct Value Plans:
Available for small groups beginning July 1, 2008, and large groups beginning October 1.
CDV 300+35 CDV 1000+50 CDV 3000+35
CDV 300+35/70% CDV 1000+50/70% CDV 3000+35/70%
CDV 300+50 CDV 1500+35 CDV 3000+50
CDV 300+50/70% CDV 1500+35/70% CDV 3000+50/70%
CDV 500+35 CDV 1500+50 CDV 5000+35
CDV 500+35/70% CDV 1500+50/70% CDV 5000+35/70%
CDV 500+50 CDV 2000+35 CDV 5000+50
CDV 500+50/70% CDV 2000+35/70% CDV 5000+50/70%
CDV 750+35 CDV 2000+50 CDV 7500+35
CDV 750+35/70% CDV 2000+50/70% CDV 7500+35/70%
CDV 750+50 CDV 2500+35 CDV 7500+50
CDV 750+50/70% CDV 2500+35/70% CDV 7500+50/70%
CDV 1000+35 CDV 2500+50  
CDV 1000+35/70% CDV 2500+50/70%  

Preferred Deductible and Percentage Plans:
80+300 80+1000 50/3750
80+500 80+1500 50/5000
80+750 80+2000 70/3500
  80+2500 BHP

Preferred Copay Plans:
15/200D 25/200D
15/50% - NEW!

Preferred FlexPerks Plans (HSA-Qualified):
No Rx Coverage: Rx Subject to Ded.:
FP 80+1100 Indexed FP 80+1100 Indexed + Rx
FP 80+1500 FP 80+1500+ Rx
FP 80+2000 FP 80+2000+ Rx
FP 80+2850 Indexed (2007) FP 80+2850 Indexed+ Rx (2007)
FP 80+2900 Indexed (2008) FP 80+2900 Indexed + Rx (2008)
FP 5000 FP 5000+ Rx
Visit our FlexPerks agent page for more information.

Prime Plans:
15/200D 500+25
25/200D 1000+35

Choice Plans:
15/200D 25/200D

Dual Choice Packages:
Package 1 Package 3 Package 5
Package 2 Package 4 Package 6

OPTIONAL BENEFITS

Prescription Drug Plans:
Tiered 10/20/40 $100 Ded. Tiered 10/20/40
Tiered 15/30/50 $200 Ded. Tiered 15/30/50
Tiered Value Plan 10/50/75 Rx BHP
Rx 20% Rx 50%  Rx 15/50%

Dental Plans:
Preventive $25/$1,000 Comp Plus $50/$1,000 Comp $50/$1,500
Preventive $50/$1,000 Comp Plus $25/$1,500 Comp Value
Preventive $25/$1,500 Comp Plus $50/$1,500 Incentive Dental $1,000
Preventive $50/$1,500 Comp $25/$1,000 Incentive Dental $1,500
Preventive Value Comp $50/$1,000 Orthodontia
Comp Plus $25/$1,000 Comp $25/$1,500

Vision Plans:
Vision Vision Plus Vision Exam Only

Alternative Care & Chiropractic Care Plans:
Chiro Plus $500 max Alt Care $500 max Alt Care/Chiro combined $500 max
Chiro Plus $1,000 max Alt Care $1,000 max Alt Care/Chiro combined $1,000 max
Chiro Plus $1,500 max Alt Care $1,500 max Alt Care/Chiro combined $1,500 max

Other Optional Benefits:
Additional Accident Benefit
First-Dollar Preventive Care Benefit

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