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:

2018 Plans

2018 Notice of Change samples: with vision, without vision

2018 Sales Brochure

2017 Plans

Forms

Additional Materials

 

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

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

 

2017 Plans


PacificSource (PSN) or SmartChoice (SCN) Network Plans:  

  • 1500+35_30+Rx     PSN / SCN
  • 2000+35_30+Rx     PSN /  SCN
  • 3000+35_30+Rx     PSN /  SCN
  • 5000+35_30+Rx     PSN /  SCN  

     Prescription Drug Benefits: 

Medical with Integrated Rx:  

  • 1500+35_30+Rx     PSN / SCN
  • 2000+35_30+Rx     PSN /  SCN
  • 3000+35_30+Rx     PSN /  SCN
  • 5000+35_30+Rx     PSN /  SCN  

HSA-qualified Medical Plans:

  • HSA 3000_50_Rx    PSN / SCN
  • HSA 6000_Rx          PSN / SCN

Chamber Core Plans:

    Vision Care Benefits:  Vision 10-150

    Alternative Care Benefits:  Acupuncture and chiropractic manipulation

    Dental:

    *Groups of 10 or more enrolled employees may purchase orthodontia coverage with any of the above dental policies.

      

    Forms


    Renewal Confirmation

    2018 Member Group Application (Master Application)

    Enrollment Application and Waiver of Coverage

    COBRA Initial Notice (Continuation Coverage Rights Under COBRA)

    Continuation Election Form (Federal, Word format) ( en Español)

    Group Authorization Agreement for Recurring Electronic Fund Transfers (EFT)

    Associate Membership Application

    Affidavit of Domestic Partnership

    Termination of Dependent Coverage  

    Wellness Commitment Certificate:

     

    Additional Materials


    Sales:  

    Underwriting Guidelines for the Bend Chamber Plans

    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 >

     

     

    Last updated 5/21/2018