NFIB: PacificSource Health Plans

Welcome to the National Federation for Independent Business (NFIB) plan information page. The summaries below provide an overview of PacificSource coverage options available through your NFIB membership. In order to be eligible to enroll your group, you will need to have at least two employees that work a minimum of 20 hours per week. In addition, a minimum of two employees will need to enroll to be eligible for a PacificSource plan. If your company has only two employees and they are related, each would need to enroll separately, instead of as an employee with a dependent.  

Forms and Materials

Request for Group Insurance (Master Application)

NFIB Renewal Confirmation 

Group Authorization Agreement for Recurring Electronic Fund Transfers  (Group EFT form)

NFIB Renewal Cover Letter  

NFIB Timeline  

Straight Talk About Healthcare Costs sales flier  

Value Added Programs and Services sales flier  

Plan Summaries (effective January 1, 2013)

Benefit Limitations and Exclusions 

HMO-1000-20-70-3500  

HSA-100-3000 E  

HSA-100-3000_NE  

HSA-100-5000 NE  

Indemnity-2500  

PPO-80-500 2000  

Rx-20-40-60  

Rx-20-40-60-$200Ded  

Rx-HSA

Vision Exam-Only