Oregon Small Business Groups

Broker Portfolio Guide

• Portfolio Guide - 2022 (PDF)

Plan Portfolio Desktopper

• Portfolio Plan Desktopper - 2022 (PDF)

Employer Group Renewal Guide

• Renewal Guide - January 2022 (PDF)

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

• Renewal Election Form - 2022 (PDF)

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

• Pharmacy Reimbursement Form (PDF)
  

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

• Disabled Dependent Certification (PDF)
• Medical Claim Reimbursement Form & Foreign Claim Questionnaire (PDF)
• Wellness PayBack Claim Form (PDF)
• Coordination of Benefits Form (PDF)
• Provider Nomination Form (PDF)
• First Health Provider Nomination Form (PDF)

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.

• Oregon Standard Gold Plan Overview (PDF)
• Oregon Standard Silver Plan Overview (PDF)
• Oregon Standard Bronze Plan Overview (PDF)

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.

• Oregon Standard Gold Plan Overview (PDF)
• Oregon Standard Silver Plan Overview (PDF)
• Oregon Standard Bronze Plan Overview (PDF)

Alternative Care

• Base Plan (PDF)
• Buy-Up Plan 1 (PDF)
• Buy-Up Plan 2 (PDF)
• Buy-Up Plan 3 (PDF)

Pediatric Dental and Vision

• Pediatric Vision and Dental (PDF)

Vision

• Preferred Plan 1025-2 (PDF)
• Preferred Plan 1025-3 (PDF)
• Elite 1010-1 (PDF)

Dental

• Essential D50-16-500 (PDF)
• Plus D50-1855-1500 (PDF)
• Preferred Plus DP50-1855-1500 (PDF)
• Value D50-185-1500V (PDF)

Alternative Care

• CAM 15-1000 (PDF)
• CAM 15-1000 Plus (PDF)
• CAM 15-1500 (PDF)
• Core CAM (PDF)
  

Pediatric Dental and Vision

• Pediatric Dental and Vision (PDF)

Vision

• Preferred Plan 1025-2 (PDF)
• Preferred Plan 1025-3 (PDF)
• Elite 1010-1 (PDF)

Dental

• Essential D50-16-500 (PDF)
• Plus D50-1855-1500 (PDF)
• Preferred Plus DP50-1855-1500 (PDF)
• Value D50-185-1500V (PDF)

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.

• SBC Employer Group Instructions Sheet (PDF)
• SBC Online Lookup Tool Instructions (PDF)

CommunityCare

• Health Net CommunityCare (PDF)

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.

• Medical Underwriting Guidelines - 2022 (PDF)
• Life Underwriting Guidelines - 2022 (PDF)

• 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)

• Health & Wellness Program and Services Guide (PDF)
• 2022 Wellness Webinar Schedule (PDF)