Sample Plan Summaries for Oregon

The sample summaries below are approved PacificSource small employer plan designs effective January 1, 2009. At 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, or summaries of plans offered prior to January 1, 2009, contact your regional PacificSource office.

Group Medical Plans

Preferred CoDeduct Plans

300+15	300+25	500+25
500+15	500+35	750+15
750+25	750+35	1000+15
1000+25	1000+35	1000+50
1500+25	1500+35	1500+50
2000+25	2000+35	2000+35-70%
2000+50	2500+25	2500+35
2500+50	3000+35-70%

Preferred CoDeduct Value Plans

CDV500+50	CDV500+50_70%	CDV750+35
CDV750+35_70%	CDV750+50	CDV750+50_70%
CDV 1000+35	CDV 1000+35_70%	CDV 1000+50
CDV 1000+50_70%	CDV1500+35	CDV1500+35_70%
CDV1500+50	CDV1500+50_70%	CDV2000+35
CDV2000+35_70%	CDV2000+50	CDV2000+50_70%
CDV2500+35	CDV2500+35_70%	CDV2500+50
CDV2500+50_70%	CDV3000+35	CDV3000+35_70%
CDV3000+50	CDV3000+50_70%	CDV5000+35
CDV5000+35_70%	CDV5000+50	CDV5000+50_70%
CDV7500+35	CDV7500+35_70%	CDV7500+50
CDV7500+50_70%	CDV300+35	CDV300+35_70%
CDV300+50	CDV300+50_70%	CDV500+35
CDV500+35_70%

Preferred Deductible and Percentage Plans

50/5000	70/3500	80+300
80+500	80+750	80+1000
80+1500	80+2000	80+2500
BHP	50/3750

Preferred CoPay Plans

25/200D

15/50%

15/200D

Preferred FlexPerks Plans

Prime Plans

Prime25_200D	Prime500+25	Prime1000+35
Prime15_200D

Choice Plans

Choice 15/200D

Choice 25/200D

Dual Choice Plans

Package 1	Package 2	Package 3
Package 4	Package 6	Package 5

Optional Benefits

Prescription Drug Plans

Rx BHP	Tiered 10/20/40	Tiered 15/30/50
Tiered Value Plan 10/50/75	Rx 50%	$200 Ded. Tiered 15/30/50
Rx 15/50%

Dental Plans

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

Vision Plans

Vision Exam Only

Vision Plus

Vision

Alternative Care and Chiropractic Benefits

Alt Care/Chiro $500 max	Alt Care/Chiro $1,000 max	Chiro Plus $1,500 max
Chiro Plus $500 max	Chiro Plus $1,000 max	Alt Care $1,500 max
Alt Care $500 max	Alt Care $1,000 max	Alt Care/Chiro $1,500 max

Other Optional Benefits

Additional Accident

First-Dollar Preventive Care Benefit

Benefits for Large Group Only (51+ Employees)

ChiroPlus$2500

AltCare$2500

AltCare+Chiro$2500

InTouch Login

Access your PacificSource account information 24/7.

Looking for more plan summaries?

Sample Idaho plan summaries
Oregon Spanish language plan summaries
For group-specific benefit summaries, please contact your regional PacificSource office.

Last updated 2/20/2009