Oregon Small Business Groups

PPO Summary of Benefits and Coverage

• OR S PPO PLT P10-250-1-3500DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO PLT P10-500-1-3500DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO PLT P10-750-1-3500DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P10-1500-4-8975DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P10-3500-4-8975DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-1000-2-8500DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-1500-2-8500DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-2000-2-8500DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-2500-2-8500DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-3000-2-8500DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P25-500-2-8550DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P25-2000-2-7000DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P35-4500-3-8975DX with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P35-5000-3-8975ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P40-3000-3-8975ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P40-6000-3-8975ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• OR S PPO BRZ P8250-0-8250ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)

PPO High Deductible Summary of Benefits and Coverage

• PPO High Deductible – OR S PPO HEQ HSAF ED SVR HD3300-3-6750ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAI ED SVR HDE3300-3-6750ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAF ED SVR HD4000-3-6750ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAI ED SVR HD4000-3-6750ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAF ED BRZ HD7100-0-7100ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAI ED BRZ HD7100-0-7100ES with Ped Dental – 2025 Summary of Benefits and Coverage – English (PDF)

Standard Summary of Benefits and Coverage

• Oregon Gold – 2025 Summary of Benefits and Coverage – English (PDF)
• Oregon Standard Silver – 2025 Summary of Benefits and Coverage – English (PDF)
• Oregon Standard Bronze – 2025 Summary of Benefits and Coverage – English (PDF)

PPO Summary of Benefits and Coverage

• OR S PPO PLT P10-250-1-3000DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO PLT P10-250-1-3000DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO PLT P10-500-1-3000DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO PLT P10-500-1-3000DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO PLT P10-750-1-3000DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO PLT P10-750-1-3000DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P0-1500-4-8500DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P0-1500-4-8500DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P0-3500-4-8500DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P0-3500-4-8500DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P25-500-2-8550DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P25-500-2-8550DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-1000-2-8500DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-1000-2-8500DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-2000-2-8500DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-2000-2-8500DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-2500-2-8500DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-2500-2-8500DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-1500-2-8500DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-1500-2-8500DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-3000-2-8500DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO GLD P15-3000-2-8500DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P35-4500-3-8750DX – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P35-4500-3-8750DX with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P40-3000-3-8975ES – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P40-3000-3-8975ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P35-5000-3-8750ES – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P35-5000-3-8750ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P40-6000-3-8750ES – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO SVR P40-6000-3-8750ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO BRZ P8250-0-8250ES – 2024 Summary of Benefits and Coverage – English (PDF)
• OR S PPO BRZ P8250-0-8250ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)

PPO High Deductible Summary of Benefits and Coverage

• PPO High Deductible – OR S PPO HEQ HSAF ED SVR HDE3200-3-6750ES – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAF ED SVR HDE3200-3-6750ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAI ED SVR HDE3200-3-6750ES – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAI ED SVR HDE3200-3-6750ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAF ED SVR HD4000-3-6750ES – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAF ED SVR HD4000-3-6750ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAI ED SVR HD4000-3-6750ES – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAI ED SVR HD4000-3-6750ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAF ED BRZ HD7100-0-7100ES – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAF ED BRZ HD7100-0-7100ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAI ED BRZ HD7100-0-7100ES – 2024 Summary of Benefits and Coverage – English (PDF)
• PPO High Deductible – OR S PPO HEQ HSAI ED BRZ HD7100-0-7100ES with Ped Dental – 2024 Summary of Benefits and Coverage – English (PDF)

Standard Summary of Benefits and Coverage

• Oregon Standard Gold – 2024 Summary of Benefits and Coverage – English (PDF)
• Oregon Standard Silver – 2024 Summary of Benefits and Coverage – English (PDF)
• Oregon Standard Bronze – 2024 Summary of Benefits and Coverage – English (PDF)

Broker Portfolio Guide

• Portfolio Guide - 2025 (PDF)
• Portfolio Guide - 2024 (PDF)

Plan Portfolio Desktopper

• Portfolio Plan Desktopper - 2025 (PDF)
• Portfolio Plan Desktopper - 2024 (PDF)

Employer Group Renewal Guide

• Renewal Guide - January 2025 (PDF)
• Renewal Guide - January 2024 (PDF)

Presentation Folder

Note: For example only. Folders can be ordered on CustomPoint

• Generic Folder – English (PDF)

New Group Implementation Forms

• Sold Group Checklist Form – English (PDF)
• 2025 – Group Plan Contract Application – English (PDF)
• 2025 – Group Plan Contract Application – En Español (Spanish) (PDF)
• 2024 – Group Plan Contract Application – English (PDF)
• 2024 – Group Plan Contract Application – En Español (Spanish) (PDF)
• 2025 – SBG Enrollment Census (XLSX)
• 2024 – SBG Enrollment Census (XLSX)
• Employee Census Form – English (PDF)
• Small Group Census Enrollment Guide – English (PDF)
• Electronic Check Form – Binder Payment – English (PDF)

Employee Enrollment and Change Forms

• 2025 – Small Business Group Employee Enrollment and Change Form – English (PDF)
• 2025 – Small Business Group Employee Enrollment and Change Form – En Español (Spanish) (PDF)
• 2024 – Employee Enrollment and Change Form – English (PDF)
• 2024 – Employee Enrollment and Change Form – En Español (Spanish) (PDF)

Renewal Election Form

• 2025 – Renewal Election Form – English (PDF)
• 2024 – Renewal Election Form – English (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 – En Español (Spanish) (PDF)

Pharmacy Reimbursement Form

• Pharmacy Reimbursement Form – English (PDF)

Continuation of Coverage Forms

• Federal Continuation Election Form – COBRA – English (PDF)
• Federal Continuation Election Form – COBRA – En Español (Spanish) (PDF)
• 2025 – Oregon State Continuation Election Form – English (PDF)
• 2024 – Oregon State Continuation Election Form – English (PDF)

HIPAA Disclosures

• Employer Group Health Plan HIPAA Disclosure Directive – English (PDF)
• Authorization to Use and Disclose Health Information – English (PDF)
• Revocation of Authorization to Use and/or Disclose Health Information – English (PDF)
• Request to Access (See) Records – English (PDF)

Additional Forms and Materials

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

PPO Plans

• PPO Platinum P10-250-1-3500DX PD Plan Overview – English (PDF)
• PPO Platinum P10-500-1-3500DX PD Plan Overview – English (PDF)
• PPO Platinum P10-750-1-3500DX PD Plan Overview – English (PDF)
• PPO Gold P25-500-2-8550DX PD Plan Overview – English (PDF)
• PPO Gold P15-1000-2-8500DX PD Plan Overview – English (PDF)
• PPO Gold P15-1500-2-8500DX PD Plan Overview – English (PDF)
• PPO Gold P25-2000-2-7000DX PD Plan Overview – English (PDF)
• PPO Gold P15-2000-2-8500DX PD Plan Overview – English (PDF)
• PPO Gold P15-2500-2-8500DX PD Plan Overview – English (PDF)
• PPO Gold P15-3000-2-8500DX PD Plan Overview – English (PDF)
• PPO Gold P10-1500-4-8975DX PD Plan Overview – English (PDF)
• PPO Gold P10-3500-4-8975DX PD Plan Overview – English (PDF)
• PPO Silver P40-3000-3-8975ES PD Plan Overview – English (PDF)
• PPO Silver P35-4500-3-8975DX PD Plan Overview – English (PDF)
• PPO Silver P35-5000-3-8975ES PD Plan Overview – English (PDF)
• PPO Silver P40-6000-3-8975ES PD Plan Overview – English (PDF)
• PPO Bronze P8250-0-8250ES PD Plan Overview – English (PDF)

PPO High Deductible Plans

• PPO Silver High Deductible 3300-3-6750ES PD Plan Overview – English (PDF)
• PPO Silver High Deductible 4000-3-6750ES PD Plan Overview – English (PDF)
• PPO High Deductible 7100-0-7100ES PD Plan Overview – English (PDF)

Health Net Oregon Gold Plan and Standard PPO Plans

• Health Net Oregon Gold Plan – English (PDF)
• Silver Standard Plan – English (PDF)
• Bronze Standard Plan – English (PDF)

PPO Plans

• PPO Platinum P10-250-1-3000DX Plan Overview – English (PDF)
• PPO Platinum P10-500-1-3000DX Plan Overview – English (PDF)
• PPO Platinum P10-750-1-3000DX Plan Overview – English (PDF)
• PPO Gold P25-500-2-8550DX Plan Overview – English (PDF)
• PPO Gold P15-1000-2-8500DX Plan Overview – English (PDF)
• PPO Gold P15-1500-2-8500DX Plan Overview – English (PDF)
• PPO Gold P15-2000-2-8500DX Plan Overview – English (PDF)
• PPO Gold P15-2500-2-8500DX Plan Overview – English (PDF)
• PPO Gold P15-3000-2-8500DX Plan Overview – English (PDF)
• PPO Gold P0-1500-4-8500DX Plan Overview – English (PDF)
• PPO Gold P0-3500-4-8500DX Plan Overview – English (PDF)
• PPO Silver P40-3000-3-8975ES Plan Overview – English (PDF)
• PPO Silver P35-4500-3-8750DX Plan Overview – English (PDF)
• PPO Silver P35-5000-3-8750ES Plan Overview – English (PDF)
• PPO Silver P40-6000-3-8750ES Plan Overview – English (PDF)
• PPO Bronze P8250-0-8250ES Plan Overview – English (PDF)

PPO High Deductible Plans

• PPO Silver High Deductible 3200-3-6750ES Plan Overview – English (PDF)
• PPO Silver High Deductible 4000-3-6750ES Plan Overview – English (PDF)
• PPO High Deductible 7100-0-7100ES Plan Overview – English (PDF)

PPO Standard Plans

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

Alternative Care

• 2025 Alternative Care – English (PDF)
• 2025 Alternative Care – En Español (Spanish) (PDF)

Pediatric Dental and Vision

• Pediatric Dental and Vision – English (PDF)
• Pediatric Dental and Vision – En Español (Spanish) (PDF)

Vision

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

Dental

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

Alternative Care

• 2024 Alternative Care – English (PDF)

Pediatric Dental and Vision

• Pediatric Dental and Vision – English (PDF)

Vision

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

Dental

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

2025 Guidelines

• Medical Underwriting Guidelines – 2025 (PDF)
• Life Underwriting Guidelines – 2025 (PDF)

2024 Guidelines

• Medical Underwriting Guidelines – 2024 (PDF)
• Life Underwriting Guidelines – 2024 (PDF)

• Healthy Discounts Booklet (PDF)
• Health and Wellness Brochure (PDF)
• Preventive Care and Screenings (Facts about ACA-Covered Services) – English (PDF)
• Preventive Care and Screenings (Facts about ACA-Covered Services) – En Español (Spanish) (PDF)
• Active&Fit™ Direct Program Flyer (PDF)
• How to Register for Sharecare (PDF)
• Sharecare FAQs (PDF)
• Sharecare Unwinding Program Flyer (PDF)
• Sharecare Unwinding Program FAQs (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)