Oregon Small Business Groups
PPO Summary of Benefits and Coverage
- OR S PPO PLT P10-250-1-3000DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-250-1-3000DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-500-1-3000DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-500-1-3000DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-750-1-3000DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-750-1-3000DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P0-1500-4-8500DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P0-1500-4-8500DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P0-3500-4-8500DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P0-3500-4-8500DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P25-500-2-8550DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P25-500-2-8550DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-1000-2-8500DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-1000-2-8500DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-2000-2-8500DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-2000-2-8500DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-2500-2-8500DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-2500-2-8500DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-1500-2-8500DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-1500-2-8500DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-3000-2-8500DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P15-3000-2-8500DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P35-4500-3-8750DX β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P35-4500-3-8750DX with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P40-3000-3-8975ES β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P40-3000-3-8975ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P35-5000-3-8750ES β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P35-5000-3-8750ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P40-6000-3-8750ES β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P40-6000-3-8750ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO BRZ P8250-0-8250ES β 2024 Summary of Benefits and Coverage β English (PDF)
- OR S PPO BRZ P8250-0-8250ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
PPO High Deductible Summary of Benefits and Coverage
- PPO High Deductible β OR S PPO HEQ HSAF ED SVR HDE3200-3-6750ES β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED SVR HDE3200-3-6750ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HDE3200-3-6750ES β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HDE3200-3-6750ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED SVR HD4000-3-6750ES β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED SVR HD4000-3-6750ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HD4000-3-6750ES β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HD4000-3-6750ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED BRZ HD7100-0-7100ES β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED BRZ HD7100-0-7100ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED BRZ HD7100-0-7100ES β 2024 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED BRZ HD7100-0-7100ES with Ped Dental β 2024 Summary of Benefits and Coverage β English (PDF)
Standard Summary of Benefits and Coverage
PPO Summary of Benefits and Coverage
- OR S PPO PLT P10-250-1-4000LX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-250-1-4000LX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-500-1-4000LX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-500-1-4000LX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-750-2-3500LX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO PLT P10-750-2-3500LX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P0-1500-4-8000DX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P0-1500-4-8000DX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P0-3500-4-8000DX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P0-3500-4-8000DX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P20-500-3-7900DX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P20-500-3-7900DX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P20-1000-2-7950DX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P20-1000-2-7950DX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P20-2000-2-7900DX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P20-2000-2-7900DX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P20-2500-3-7900DX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P20-2500-3-7900DX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P30-1500-2-7900DX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P30-1500-2-7900DX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P30-3500-3-7900DX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P30-3500-3-7900DX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P50-0-5-5000 β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO GLD P50-0-5-5000 with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P35-5000-5-8500DX β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P35-5000-5-8500DX with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P45-3500-5-8150ES β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P45-3500-5-8150ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P45-4000-3-8150ES β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P45-4000-3-8150ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P45-5000-5-8150ES β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P45-5000-5-8150ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P45-6000-5-8500ES β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO SVR P45-6000-5-8500ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO BRZ P8250-0-8250ES β 2023 Summary of Benefits and Coverage β English (PDF)
- OR S PPO BRZ P8250-0-8250ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
PPO High Deductible Summary of Benefits and Coverage
- PPO High Deductible β OR S PPO HEQ HSAF ED SVR HDE3000-3-6750ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED SVR HDE3000-3-6750ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED SVR HDE4000-3-6750ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED SVR HDE4000-3-6750ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED BRZ HDE6900-0-6900ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAF ED BRZ HDE6900-0-6900ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HDE6900-0-6900ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HDE6900-0-6900ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HDE3000-3-6750ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HDE3000-3-6750ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HDE4000-3-6750ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HEQ HSAI ED SVR HDE4000-3-6750ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAF ED SVR HD3000-3-6750ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAF ED SVR HD3000-3-6750ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAF ED SVR HD4000-3-6750ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAF ED SVR HD4000-3-6750ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAF ED BRZ HD6900-0-6900ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAF ED BRZ HD6900-0-6900ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAI ED SVR HD3000-3-6750ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAI ED SVR HD3000-3-6750ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAI ED SVR HD4000-3-6750ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAI ED SVR HD4000-3-6750ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAI ED BRZ HD6900-0-6900ES β 2023 Summary of Benefits and Coverage β English (PDF)
- PPO High Deductible β OR S PPO HSAI ED BRZ HD6900-0-6900ES with Ped Dental β 2023 Summary of Benefits and Coverage β English (PDF)
Standard Summary of Benefits and Coverage
Broker Portfolio Guide
Plan Portfolio Desktopper
Employer Group Renewal Guide
New Group Implementation Forms
- Sold Group Checklist Form β English (PDF)
- Group Plan Contract Application β 2024 β English (PDF)
- Group Plan Contract Application β 2024 β En EspaΓ±ol (Spanish) (PDF)
- Group Plan Contract Application β 2023 β English (PDF)
- Group Plan Contract Application β 2023 β En EspaΓ±ol (Spanish) (PDF)
- SBG Enrollment Census β 2024 (XLSX)
- SBG Enrollment Census β 2023 (XLSX)
- Employee Census Form β English (PDF)
- Small Group Census Enrollment Guide β English (PDF)
- Electronic Check Form β Binder Payment β English (PDF)
Employee Enrollment and Change Forms
- Employee Enrollment and Change Form β 2024 β English (PDF)
- Employee Enrollment and Change Form β 2024 β En EspaΓ±ol (Spanish) (PDF)
- Employee Enrollment and Change Form β 2023 β English (PDF)
- Employee Enrollment and Change Form β 2023 β En EspaΓ±ol (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 β English (PDF)
- Getting Started With Mail Order Pharmacy Kit β En EspaΓ±ol (Spanish) (PDF)
Pharmacy Reimbursement Form
Continuation of Coverage Forms
- Federal Continuation Election Form β COBRA β English (PDF)
- Federal Continuation Election Form β COBRA β En EspaΓ±ol (Spanish) (PDF)
- Oregon State Continuation Election Form β 2024 β English (PDF)
- Oregon State Continuation Election Form β 2023 β English (PDF)
HIPAA Disclosures
- Employer Group Health Plan HIPAA Disclosure Directive β English (PDF)
- Authorization to Use and Disclose Health Information β English (PDF)
- Revocation of Authorization to Use and/or Disclose Health Information β English (PDF)
- Request to Access (See) Records β English (PDF)
Additional Forms and Materials
- Disabled Dependent Certification β English (PDF)
- Medical Claim Reimbursement Form & Foreign Claim Questionnaire β English (PDF)
- Wellness PayBack Claim Form β English (PDF)
- Coordination of Benefits Form β English (PDF)
- Provider Nomination Form β English (PDF)
- First Health Provider Nomination Form β English (PDF)
PPO Plans
- PPO Platinum P10-250-1-3000DX Plan Overview β English (PDF)
- PPO Platinum P10-500-1-3000DX Plan Overview β English (PDF)
- PPO Platinum P10-750-1-3000DX Plan Overview β English (PDF)
- PPO Gold P25-500-2-8550DX Plan Overview β English (PDF)
- PPO Gold P15-1000-2-8500DX Plan Overview β English (PDF)
- PPO Gold P15-1500-2-8500DX Plan Overview β English (PDF)
- PPO Gold P15-2000-2-8500DX Plan Overview β English (PDF)
- PPO Gold P15-2500-2-8500DX Plan Overview β English (PDF)
- PPO Gold P15-3000-2-8500DX Plan Overview β English (PDF)
- PPO Gold P0-1500-4-8500DX Plan Overview β English (PDF)
- PPO Gold P0-3500-4-8500DX Plan Overview β English (PDF)
- PPO Silver P40-3000-3-8975ES Plan Overview β English (PDF)
- PPO Silver P35-4500-3-8750DX Plan Overview β English (PDF)
- PPO Silver P35-5000-3-8750ES Plan Overview β English (PDF)
- PPO Silver P40-6000-3-8750ES Plan Overview β English (PDF)
- PPO Bronze P8250-0-8250ES Plan Overview β English (PDF)
PPO High Deductible Plans
- PPO Silver High Deductible 3200-3-6750ES Plan Overview β English (PDF)
- PPO Silver High Deductible 4000-3-6750ES Plan Overview β English (PDF)
- PPO High Deductible 7100-0-7100ES Plan Overview β English (PDF)
PPO Standard Plans
PPO Plans
- PPO Platinum P10-250-1-4000LX Plan Overview β English (PDF)
- PPO Platinum P10-500-1-4000LX Plan Overview β English (PDF)
- PPO Platinum P10-750-2-3500LX Plan Overview β English (PDF)
- PPO Gold P50-0-5-5000 Plan Overview β English (PDF)
- PPO Gold P0-1500-4-8000DX Plan Overview β English (PDF)
- PPO Gold P0-3500-4-8000DX Plan Overview β English (PDF)
- PPO Gold P20-500-3-7900DX Plan Overview β English (PDF)
- PPO Gold P20-1000-2-7950DX Plan Overview β English (PDF)
- PPO Gold P20-2000-2-7900DX Plan Overview β English (PDF)
- PPO Gold P20-2500-3-7900DX Plan Overview β English (PDF)
- PPO Gold P30-1500-2-7900DX Plan Overview β English (PDF)
- PPO Gold P30-3500-3-7900DX Plan Overview β English (PDF)
- PPO Silver P35-5000-5-8500DX Plan Overview β English (PDF)
- PPO Silver P45-3500-5-8150ES Plan Overview β English (PDF)
- PPO Silver P45-4000-3-8150ES Plan Overview β English (PDF)
- PPO Silver P45-5000-5-8150ES Plan Overview β English (PDF)
- PPO Silver P45-6000-5-8500ES Plan Overview β English (PDF)
- PPO Bronze P8250-0-8250ES Plan Overview β English (PDF)
PPO High Deductible Plans
- PPO High Deductible Silver HD3000-3-6750ES Plan Overview β English (PDF)
- PPO High Deductible Silver HD4000-3-6750ES Plan Overview β English (PDF)
- PPO High Deductible Bronze HD6900-0-6900ES Plan Overview β English (PDF)
PPO Standard Plans
Alternative Care
Pediatric Dental and Vision
Vision
- Preferred Plan 1025-2 β English (PDF)
- Preferred Plan 1025-3 β English (PDF)
- Elite 1010-1 β English (PDF)
Dental
Alternative Care
- Base Plan β English (PDF)
- Buy-Up Plan 1 β English (PDF)
- Buy-Up Plan 2 β English (PDF)
- Buy-Up Plan 3 β English (PDF)
Alternative Care High Deductible Health Plans (HSA)
Alternative Care Standard Plans
- Alternative State Standard Bronze β English (PDF)
- Alternative State Standard Silver β English (PDF)
- Alternative State Standard Gold β English (PDF)
Pediatric Dental and Vision
Vision
- Preferred Plan 1025-2 β English (PDF)
- Preferred Plan 1025-3 β English (PDF)
- Elite 1010-1 β English (PDF)
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
- Health Net Value-Add Programs Flyer (PDF)
- Prior-Carrier Deductible Credit Flyer (PDF)
- 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 β English (PDF)
- Member Handbook β En EspaΓ±ol (Spanish) (PDF)
- Same Day Care (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)
- Dental Website Overview (PDF)
- Vision Website Overview (PDF)
- Employer Portal Registration (PDF)
- Behavioral Health FAQs (PDF)
- Health Net Website Flyer (PDF)
- Find a Provider Flyer (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 β English (PDF)
- Uniform Glossary of Health Coverage and Medical Terms β En EspaΓ±ol (Spanish) (PDF)
- Uniform Glossary of Health Coverage and Medical Terms β Chinese (PDF)
- Uniform Glossary of Health Coverage and Medical Terms β Navajo (PDF)
- Uniform Glossary of Health Coverage and Medical Terms β 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.
2024 Guidelines
2023 Guidelines
- 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 – En EspaΓ±ol (Spanish) (PDF)
- Preventive Care and Screenings (Facts about ACA-Covered Services) (PDF)
- Active&Fitβ’ Direct Program Flyer β English (PDF)
- How to Register for Sharecare (PDF)
- Sharecare FAQs (PDF)
- Sharecare Unwinding Program Flyer (PDF)
- Sharecare Unwinding Program FAQs (PDF)
- Earn Green Days Overview (PDF)
- RealAge Program (PDF)
- RealAge Program FAQs (PDF)
- Eat Right Now Program Flyer (PDF)
- Eat Right Now FAQs (PDF)
- Craving to Quit Flyer (PDF)
- Craving to Quit FAQs (PDF)
- Health Coaching (Lifestyle Management) Flyer (PDF)
- Health Coaching (Lifestyle Management) FAQs (PDF)