Bend Chamber of Commerce:
PacificSource Health Plans

Bend Chamber logoAgents and agencies are required to be licensed in the State of Oregon, appointed with PacificSource Health Plans and Johnson Benefit Planning, and a member of the Bend Chamber in good standing. 

Coverage at a glance:

  • At least two people need to enroll in a group. 
  • Domestic Partner Benefits are available to all groups.
  • Dental plans are available to all medical groups and on a stand-alone basis for groups of five or more.
  • Orthodontic coverage is available to groups of 10 or more enrolled employees.
  • Acupuncture/Chiropractic Manipulation coverage is available to all groups.
  • Vision coverage is available to all groups.

For more information, please refer to the Bend Chamber sales brochure, or contact:

Johnson Benefit Planning
(541) 382-3571 or toll-free (800) 314-3571
Fax: (541) 382-3807
Email: Lisa Thompson at  Lisa@johnsonbenefitplanning.com
Website: johnsonbenefitplanning.com  
777 NW Wall St Ste 100, Bend OR 97701

Quick Links:

2019 Plans

2018 Plans

2019 Notice of Change

2019 Sales Brochure

Forms

Additional Materials

 

2019 Plans 

Medical Plan

Deductible

Out-of-pocket limit

Office visits

Co-insurance

Summaries 
by Network
Summaries 
by Network
Premier Plans         Summaries
by Network with
10-50-75 Pharmacy Plan
Summaries
by Network with
10-50p-50p Pharmacy Plan
1000+25-50_20 S2 $1,000 $4,000   $25-50 co-pay^ After deductible, 20% PacificSource / SmartChoice PacificSource / SmartChoice
1500+25-50_30 S2 $1,500 $5,000   $25-50 co-pay^ After deductible, 30% PacificSource / SmartChoice PacificSource / SmartChoice
2000+25-50_30 S2 $2,000 $6,850 $25-50 co-pay^ After deductible, 30% PacificSource / SmartChoice PacificSource / SmartChoice
3000+35-60_30 S2 $3,000 $7,500 $35-60 co-pay^ After deductible, 30% PacificSource / SmartChoice PacificSource / SmartChoice
5000+35-60_30 S2 $5,000 $7,500 $35-60 co-pay^ After deductible, 30% PacificSource / SmartChoice PacificSource / SmartChoice
HSA Plans        
 
 HSA 3000_50_Rx S2 $3,000 $6,000 After deductible, 50% After deductible, 50% PacificSource / SmartChoice -
 HSA 4000+Rx  $4,000 $4,000 After deductible, covered in full After deductible, covered in full PacificSource / SmartChoice -
 HSA 6000+Rx $6,000 $6,000 After deductible, covered in full After deductible, covered in full PacificSource / SmartChoice -
Chamber Core Plan        
Chamber Core 5000+35-70_50 $5,000 $7,000 $35-70 co-pay^ After deductible, 50% - PacificSource / SmartChoice

^not subject to deductible

Dental Plans

Dental Advantage  0-20-50 50-1000

Dental Advantage  20-50-75 50-1000

Dental Advantage  0-20-50 50-1500

Orthodontia 1000

Vision

10-200

Chiropractic Manipulation and Acupuncture

1000

 

2018 Plans

Medical Plan

Deductible

Out-of-pocket limit

Office visits

Co-insurance

Summaries 
by Network with 
10-50-75 Pharmacy Plan
Summaries 
by Network with 
10-50p-50p Pharmacy Plan
1500+25-50_30 $1,500 $5,000   $25-50 co-pay^ After deductible, 30% PacificSource / SmartChoice PacificSource / SmartChoice
2000+25-50_30 $2,000 $6,850 $25-50 co-pay^ After deductible, 30% PacificSource / SmartChoice PacificSource / SmartChoice
3000+25-50_30 $3,000 $6,850 $25-50 co-pay^ After deductible, 30% PacificSource / SmartChoice PacificSource / SmartChoice
5000+25-50_30 $5,000 $7,000 $25-50 co-pay^ After deductible, 30% PacificSource / SmartChoice PacificSource / SmartChoice
Chamber Core 5000+35-70_50 $5,000 $7,000 $35-70 co-pay^ After deductible, 50% - PacificSource / SmartChoice
HSA-qualified Plan         Summaries
by Network with
50p Pharmacy Plan
Summaries
by Network with
6000D Pharmacy Plan
 HSA 3000_50+Rx  $3,000 $6,000 After deductible, 50% After deductible, 50% PacificSource / SmartChoice -
 HSA 6000+Rx $6,000 $6,000 After deductible, covered in full After deductible, covered in full - PacificSource / SmartChoice

^not subject to deductible 

Dental Plans

 

Dental Advantage  0-20-50 50-1000

Dental Advantage  0-20-50 50-1500

Dental Advantage  20-50-75 50-1000

Orthodontia 1000


Vision

10-150

Chiropractic Manipulation and Acupuncture

1000

 

Forms


2019 Enrollment Application and Waiver of Coverage

2018 Enrollment Application and Waiver of Coverage

Renewal Confirmation

2019 Member Group Application (Master Application)

2018 Member Group Application (Master Application)

COBRA Administration Application (through PacificSource Administrators)

Group Authorization Agreement for Recurring Electronic Fund Transfers (EFT)

Associate Membership Application

Termination of Dependent Coverage

If you do not elect COBRA administration through PacificSource Administrators, please use the forms below:

USAable Life:

Wellness Commitment Certificate:

 

Additional Materials


Sales:  

Underwriting Guidelines for the Bend Chamber Plans

Medicare Part D Creditability Matrix (2019)

Value-Added Programs and Services

InTouch for Employers

Global Emergency Services from Assist America  

Member Fliers:

InTouch: Access Your Plan Info from Your Computer, Tablet, or Phone

Provider Directory - Online

Quit For Life (tobacco cessation program)  

24-Hour NurseLine  

CaféWell: Personalized Healthy Life Guidance  

Hospital-based Health Education Classes  

More forms and materials for members >