Oregon Small Business Groups
Broker Portfolio Guide
Plan Portfolio Desktopper
Employer Group Renewal Guide
New Group Implementation Forms
- Sold Group Checklist Form (PDF)
- Group Plan Contract Application - 2022 - English (PDF)
- Group Plan Contract Application - 2022 - Spanish (PDF)
- SBG Enrollment Census - 2022 (xlsx)
- Employee Census Form (PDF)
- Electronic Check Form - Binder Payment (PDF)
Employee Enrollment and Change Forms
- Employee Enrollment and Change Form - 2022 - English (PDF)
- Employee Enrollment and Change Form - 2022 - Spanish (PDF)
- Employee Enrollment and Change Form - 2021 - English (PDF)
- Employee Enrollment and Change Form - 2021 - Spanish (PDF)
Renewal Election Form
Pharmacy
This kit is for members only and may not be included in Open Enrollment Kits.
- Getting Started With Mail Order Pharmacy Kit - English (PDF)
- Getting Started With Mail Order Pharmacy Kit - Spanish (PDF)
Pharmacy Reimbursement Form
Continuation of Coverage Forms
- Federal Continuation Election Form - COBRA - English (PDF)
- Federal Continuation Election Form - COBRA - Spanish (PDF)
- Oregon State Continuation Election Form - 2022 (PDF)
HIPAA Disclosures
- Employer Group Health Plan HIPAA Disclosure Directive (PDF)
- Authorization to Use and Disclose Health Information (PDF)
- Revocation of Authorization to Use and/or Disclose Health Information (PDF)
- Request to Access (See) Records (PDF)
Additional Forms and Materials
CommunityCare 1T Plans
Available to Oregon groups located in Multnomah, Clackamas, Washington, Clatsop, Columbia, and Tillamook counties.
- CommunityCare 1T 15-500-1-3000DX Plan Overview (PDF)
- CommunityCare 1T 20-750-2-3000DX Plan Overview (PDF)
- CommunityCare 1T 25-1000-2-7900DX Plan Overview (PDF)
- CommunityCare 1T 25-2000-2-7900DX Plan Overview (PDF)
- CommunityCare 1T 25-3500-2-7900DX Plan Overview (PDF)
- CommunityCare 1T 40-3000-3-8150ES Plan Overview (PDF)
- CommunityCare 1T 40-4500-3-8150ES Plan Overview (PDF)
PPO Plans
Available to Oregon groups statewide.
- PPO Platinum P10-250-1-4000LX Plan Overview (PDF)
- PPO Platinum P10-500-2-4000LX Plan Overview (PDF)
- PPO Platinum P10-750-2-4000LX Plan Overview (PDF)
- PPO Gold P50-0-5-5000 Plan Overview (PDF)
- PPO Gold P0-1500-4-7900DX Plan Overview (PDF)
- PPO Gold P0-3500-4-7900DX Plan Overview (PDF)
- PPO Gold P20-500-3-7900DX Plan Overview (PDF)
- PPO Gold P20-1000-2-7900DX Plan Overview (PDF)
- PPO Gold P20-2000-2-7900DX Plan Overview (PDF)
- PPO Gold P20-2500-3-7900DX Plan Overview (PDF)
- PPO Gold P30-1500-2-7900DX Plan Overview (PDF)
- PPO Gold P30-3500-3-7900DX Plan Overview (PDF)
- PPO Silver P20-5000-5-8150DX Plan Overview (PDF)
- PPO Silver P40-3000-3-8150ES Plan Overview (PDF)
- PPO Silver P40-4000-3-8150ES Plan Overview (PDF)
- PPO Silver P45-3500-5-8150ES Plan Overview (PDF)
- PPO Silver P45-5000-5-8150ES Plan Overview (PDF)
- PPO Bronze P8250-0-8250ES Plan Overview (PDF)
PPO High Deductible Plans
Available to Oregon groups statewide.
- PPO High Deductible Silver HD2800-2-5500ES Plan Overview (PDF)
- PPO High Deductible Silver HD3000-3-6750ES Plan Overview (PDF)
- PPO High Deductible Silver HD4000-3-6750ES Plan Overview (PDF)
- PPO High Deductible Bronze HD6900-0-6900ES Plan Overview (PDF)
PPO Standard Plans
Available to Oregon groups statewide.
CommunityCare 1T Plans
Available to Oregon groups located in Multnomah, Clackamas, Washington, Clatsop, Columbia, and Tillamook counties.
- CommunityCare 1T 15-500-1-3000DX Plan Overview (PDF)
- CommunityCare 1T 20-750-2-3000DX Plan Overview (PDF)
- CommunityCare 1T 25-1000-2-7900DX Plan Overview (PDF)
- CommunityCare 1T 25-2000-2-7900DX Plan Overview (PDF)
- CommunityCare 1T 25-3500-2-7900DX Plan Overview (PDF)
- CommunityCare 1T 40-3000-3-8150ES Plan Overview (PDF)
- CommunityCare 1T 40-4500-3-8150ES Plan Overview (PDF)
CommunityCare 3T Plans
Available to Oregon groups located in Multnomah, Clackamas, Washington, Clatsop, Columbia, and Tillamook counties.
- CommunityCare 3T 15-500-1-3000DX Plan Overview (PDF)
- CommunityCare 3T 20-750-2-3000DX Plan Overview (PDF)
- CommunityCare 3T 25-1000-2-7900DX Plan Overview (PDF)
- CommunityCare 3T 25-2000-2-7900DX Plan Overview (PDF)
- CommunityCare 3T 25-3500-2-7900DX Plan Overview (PDF)
- CommunityCare 3T 40-3000-3-8150ES Plan Overview (PDF)
- CommunityCare 3T 40-4500-3-8150ES Plan Overview (PDF)
PPO Plans
Available to Oregon groups statewide.
- PPO Platinum P10-250-1-4000LX Plan Overview (PDF)
- PPO Platinum P10-500-2-4000LX Plan Overview (PDF)
- PPO Platinum P10-750-2-4000LX Plan Overview (PDF)
- PPO Gold P50-0-5-5000 Plan Overview (PDF)
- PPO Gold P0-1500-4-7900DX Plan Overview (PDF)
- PPO Gold P0-3500-4-7900DX Plan Overview (PDF)
- PPO Gold P20-500-3-7900DX Plan Overview (PDF)
- PPO Gold P20-1000-2-7900DX Plan Overview (PDF)
- PPO Gold P20-2000-2-7900DX Plan Overview (PDF)
- PPO Gold P20-2500-3-7900DX Plan Overview (PDF)
- PPO Gold P30-1500-2-7900DX Plan Overview (PDF)
- PPO Gold P30-3500-3-7900DX Plan Overview (PDF)
- PPO Silver P20-5000-5-8150DX Plan Overview (PDF)
- PPO Silver P40-3000-3-8150ES Plan Overview (PDF)
- PPO Silver P40-4000-3-8150ES Plan Overview (PDF)
- PPO Silver P45-3500-5-8150ES Plan Overview (PDF)
- PPO Silver P45-5000-5-8150ES Plan Overview (PDF)
- PPO Bronze P8250-0-8250ES Plan Overview (PDF)
PPO High Deductible Plans
Available to Oregon groups statewide.
- PPO High Deductible Silver HD2800-2-5500ES Plan Overview (PDF)
- PPO High Deductible Silver HD3000-3-6750ES Plan Overview (PDF)
- PPO High Deductible Silver HD4000-3-6750ES Plan Overview (PDF)
- PPO High Deductible Bronze HD6900-0-6900ES Plan Overview (PDF)
PPO Standard Plans
Available to Oregon groups statewide.
Alternative Care
Pediatric Dental and Vision
Vision
Dental
Alternative Care
Pediatric Dental and Vision
Vision
Dental
SBC Distribution Information
The PDF below provides detailed instructions for distribution and reproduction of the Summary of Benefits and Coverage (SBC) document, as required under the Affordable Care Act.
CommunityCare
Additional Tools
- Teladoc Member FAQs (PDF)
- Think of Teladoc First (PDF)
- Teladoc Mental Health - Getting Started (PDF)
- EFT Set Up Instructions (PDF)
- How To Read Your Commission Statement (PDF)
- Member Handbook (PDF)
- Urgent Care vs. ER (PDF)
- Coordination of Benefits for Members (PDF)
- Generic vs Brand-Name Drugs Information (PDF)
- Employer Online Enrollment and Billing (PDF)
- First Health Network FAQs (PDF)
- Health Net Website and Mobile App How-To Flyer (PDF)
- Dental Website Overview (PDF)
- Vision Website Overview (PDF)
- Employer Portal Registration (PDF)
- Health Net Received Two National Customer Service Awards (PDF)
- Behavioral Health/MHN FAQs (PDF)
Uniform Glossary of Health Coverage and Medical Terms
Health insurance companies and group health plans are required to make available a uniform glossary of health coverage and medical terms commonly used in plan documents. The Uniform Glossary is meant to help the consumer understand some of the most common language used in health insurance documents. Please log in to request a hard copy of the document by mail.
- Uniform Glossary of Health Coverage and Medical Terms - English (PDF)
- Uniform Glossary of Health Coverage and Medical Terms - Spanish (PDF)
- Uniform Glossary of Health Coverage and Medical Terms - Chinese (PDF)
- Uniform Glossary of Health Coverage and Medical Terms - Navajo (PDF)
- Uniform Glossary of Health Coverage and Medical Terms - Korean (PDF)
Are your clients looking for greater convenience, service and choice in consumer directed health care benefits? We have partnered with HealthEquity for HSA integration alongside our Small group high deductible health plans (HDHP’s). A proven expert in financial arrangement integration and administration, HealthEquity offers easy-to-use tools and comprehensive resources.
Learn more about HealthEquity HSA Plans on the HealthEquity website. Go to HealthEquity sales resource site.
- Health & Wellness Program and Services Guide (PDF)
- Healthy Discounts Booklet (PDF)
- 2022 Wellness Webinar Schedule (PDF)
- myStrength Flyer (PDF)
- Health Net’s Preventive Screening Guidelines - English (PDF)
- Health Net's Preventive Screening Guidelines - Spanish (PDF)
- Preventive Care and Screenings (Facts about ACA-Covered Services) (PDF)
- Active&Fit Direct Member Flyer - English (PDF)
- Active&Fit Direct Member Flyer - Spanish (PDF)
- How to Register for Sharecare (PDF)
- Sharecare FAQs (PDF)
- Earn Green Days Overview (PDF)
- RealAge Program (PDF)
- RealAge Program FAQs (PDF)