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Oregon Small Business Group Plans

Health plans come in four metal levels: platinum, gold, silver and bronze.

The difference between the levels is how much you pay versus how much the health insurance company pays. Health Net offers plans in all metal levels. So we have an option for you no matter what level of coverage you want.

Note: All medical plans include pediatric vision coverage.1 


Plan Details

Health Net Health Plan of Oregon, Inc. (Health Net) Preferred Provider Organization (PPO) plans are available to Oregon groups statewide. Our PPO plans feature our widest range of deductible options to fit a variety of budgets.

PPO Platinum Member(s) Responsibility
Plan Name P10-250-1-4000LX P10-500-2-4000LX P10-750-2-4000LX
Metal Level Platinum Platinum Platinum
Deductible2
(Single/Family)
$250/
$500
$500/
$1,000
$750/
$1,500
Out-of-Pocket
Maximum3
(Single/Family)
$4,000/
$8,000
$4,000/
$8,000
$4,000/
$8,000
Office Visit
(PCP/Spec.)
$10/$20
$10/$20 $10/$20
Coinsurance4 10%/50%
20%/50%
20%/50%
Lab and X-Ray
$10
$10 $10
CT/MRI/PET/SPEC 10%5
20%5 20%5
Inpatient Hospital 10% 20% 20%
Outpatient Surgery (ASC/Hospital) 5%/10% 10%/20% 10%/20%
Emergency Room $250+10%
$250+20%
$250+20%
Urgent Care $50 $50 $50
Pharmacy7 $10/ $30/
$90/ 50%
$10/ $30/
$90/ 50%
$10/ $30/
$90/ 50%

 

PPO Gold Member(s) Responsibility
Plan Name P50-0-
5-5000
P0-1500-4-7900DX P0-3500-4-7900DX P20-
500-3-
7900DX
P20- 1000-2-
7900DX
P20-2000-2-
7900DX
P20- 2500-3- 7900DX P30-1500-2-7900DX P30-3500-3- 7900DX
Metal Level Gold Gold Gold Gold Gold Gold Gold Gold Gold
Deductible2
(Single/
Family)
$0/$0 $1,500/
$3,000
$3,500/
$7,000
$500/
$1,000
$1,000/
$2,000
$2,000/
$4,000
$2,500/
$5,000
$1,500/
$3,000
$3,500/
$7,000
Out-of-Pocket
Maximum3
(Single/
Family)
$5,000/
$10,000
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
Office Visit (PCP/Spec.) 50%/50%
$0/$50 $0/$50 $20/$40
$20/$40 $20/$40 $20/$40 $30/$60 $30/$60
Coinsurance4 50%/50%
40%/50% 40%/50% 30%/50%
20%/50%
20%/50%
30%/50%
20%/50% 30%/50%
Lab / X-Ray 50%
$0 $0 $20
$20 $20 $20 $20 $20
CT/MRI/PET/SPEC 50%
40% 40% 30%
20% 20% 30% 20% 30%
Inpatient Hospital 50% 40% 40% 30% 20% 20% 30% 20% 30%
Outpatient Hospital 40%/50% 30%/40% 30%/40% 20%/30% 10%/20% 10%/20% 20%/30% 10%/20% 20%/30%
Emergency 50%
40% 40% $250+30%
$250+20%
$250+ 20%
$250+30%
$250+20% $250+ 30%
Urgent Care 50% $50 $50 $50 $50 $50 $50 $50 $50

Pharmacy7
$15/ $45/
$90/ 50%
$250 deductible $05/ $45/ 50%/ 50% $250 deductible $05/ $45/ 50%/ 50% $15/ $45/
$90/ 50%
$15/ $45/
$90/ 50%
$20/ $45/
$90/ 50%
$20/ $45/
$90/ 50%
$15/ $45/
$90/ 50%
$20/ $45/
$90/ 50%

 

PPO Silver/Bronze Member(s) Responsibility
Plan Name P20-5000-5-8150DX P40-3000-3-8150ES P40-4000-3-8150ES P45-3500-5-8150ES P45-5000-5-8150ES P8250-0-
8250ES
Metal Level Silver Silver Silver Silver Silver Bronze
Deductible2
(Single/Family)
$5,000/
$10,000
$3,000/
$6,000
$4,000/
$8,000
$3,500/
$7,000
$5,000/
$10,000
$8,250/
$16,500
Out-of-Pocket Maximum3
(Single/Family)
$8,150/
$16,300
$8,150/
$16,300
$8,150/
$16,300
$8,150/
$16,300
$8,150/
$16,300
$8,250/
$16,500
Office Visit (PCP/Spec.) $20/$50 $40/$80 $40/$80 $45/$90 $45/$90 0%/0%
Coinsurance4 50%/50% 30%/50% 30%/50% 50%/50% 50%/50%
0%/50%
Lab / X-Ray $20 30% 30% 50% 50%
0%
CT/MRI/PET/SPEC 50% 30% 30% 50% 50%
0%
Inpatient Hospital 50% 30% 30% 50% 50% 0%
Outpatient Surgery (ASC/Hospital) 40%/50% 20%/30% 20%/30% 40%/50% 40%/50% 0%/0%
Emergency Room 50% 30% 30% 50% 50%
0%
Urgent Care $50 $80 $80 $90 $90 0%
Pharmacy7 $350 deductible $155/ $50/ 50%/ 50% $25/ $50/
50%/ 50%
$25/ $50/
50%/ 50%
$25/ $50/
50%/ 50%
$25/ $50
50%/ 50%
0%6/ 0%6/
0%6/ 0%6

 

Are My Drugs Covered?

To find out if your drugs are covered, search the
Oregon Rx Drug List (PDF)

Health Net Health Plan of Oregon, Inc. (Health Net) High Deductible Preferred Provider Organization (PPO)8 plans are available to Oregon groups statewide. Our PPO plans feature our widest range of deductible options to fit a variety of budgets.

High Deductible PPO Member(s) Responsibility
Plan Name HD2800-2-5500ES HD3000-3-6750ES HD4000-3-6750ES HD6900-0-6900ES
Metal Level Silver Silver Silver Bronze
Deductible2 (Single/Family) $2,800/
$5,600
$3,000/
$6,000
$4,000/
$8,000
$6,900/
$13,800
Out-of-Pocket Maximum3 (Single/Family) $5,500/
$11,000
$6,750/
$13,500
$6,750/
13,500
$6,900/
$13,800
Office Visit (PCP/Spec.) 20%/20% 30%/30% 30%/30% 0%/0%
Coinsurance4 20%/50% 30%/50% 30%/50% 0%/50%
Lab / X-Ray 20% 30% 30% 0%
CT/MRI/PET/SPEC 20% 30% 30% 0%
Inpatient Hospital 20% 30% 30% 0%
Outpatient Surgery (ASC/Hospital) 10%/20% 20%/30% 20%/30% 0%/0%
Emergency Room 20%
30% 30% 0%
Urgent Care 20% 30% 30% 0%
Pharmacy7 20%6/ 20%6/
20%6/ 50%6
30%6/ 30%6/
30%6/ 50%6
30%6/ 30%6/
30%6/ 50%6
0%6/ 0%6/
0%6/ 0%6

Health Net Health Plan of Oregon, Inc. (Health Net) Standard plans are available to Oregon groups statewide. The benefit design of these plans match those designated by the State of Oregon. Pediatric vision coverage is included. Pediatric dental coverage is not available with these plans. Adult dental and adult vision plans are not available with the State Standard plans.

Standard PPO Member(s) Responsibility
Plan Name Health Net Oregon Standard Plan Health Net Oregon Standard Plan Health Net Oregon Standard Plan
Metal Level Gold Silver Bronze
Deductible2
(single/family)
$1,500/
$3,000
$3,650/
$7,300
$8,550/
$17,100
Out-of-Pocket maximum3
(single/family)
$7,300/
$14,600
$8,550/
$17,100
$8,550/
$17,100
Office visit (PCP/Spec.) $20/$40 $40/$80 $50/$100
Coinsurance4 20%/50% 30%/50% 0%/50%
Lab / x-ray 20% 30% 0%
CT/MRI/PET/SPEC 20% 30% 0%
Inpatient Hospital 20% 30% 0%
Outpatient Surgery (ASC/Hospital) 20%/20% 30%/30% 0%/0%
Emergency 20%
30% 0%
Urgent Care $60 $70 $100
Pharmacy7 $10/ $30/ 50%/ 50% ($500 per script cap %) $15/ $60/ 50%/ 50% $205/ 0%6/ 0%6/ 0%6

Health Net Health Plan of Oregon, Inc. (Health Net) CommunityCare plans are available to Oregon groups located in Multnomah, Clackamas, Washington, Clatsop, Columbia, and Tillamook counties.

Our base plan, featuring the familiar single-tier benefit structure and access to the select Health Net CommunityCare network, is the most affordable CommunityCare option.

CommunityCare 1T Member(s) Responsibility
Plan Name 15-500-1-3000DX 20-750-2-3000DX 25-1000-2-7900DX 25-2000-2-7900DX 25-3500-2-7900DX 40-3000-3-8150ES 40-4500-3-8150ES
Metal Level Platinum Platinum Gold Gold Gold Silver Silver
Deductible2
(single/family)
$500/
$1,000
$750/
$1,500
$1,000/
$2,000
$2,000/
$4,000
$3,500/
$7,000
$3,000/
$6,000
$4,500/
$9,000
Out-of-Pocket maximum3
(single/family)
$3,000/
$6,000
$3,000/
$6,000
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
$8,150/
$16,300
$8,150/
$16,300
Office visit (PCP/Spec.) $15/$45 $20/$50 $25/$65 $25/$65 $25/$65 $40/$80 $40/$80
Coinsurance4 10%/Not covered 20%/Not covered 20%/Not covered 20%/Not covered 20%/Not covered 30%/Not covered 30%/Not covered
Lab / x-ray $15 $20 $25 $25 $25 30% 30%
CT/MRI/PET/SPEC 10% 20% 20% 20% 20% 30% 30%
Inpatient Hospital 10% 20% 20% 20% 20% 30% 30%
Outpatient Surgery (ASC/Hospital) 5%/10% 10%/20% 10%/20% 10%/20% 10%/20% 20%/30% 20%/30%
Emergency $250+10% $250+20%
$250+20%
$250+20% $250+20% 30% 30%
Urgent Care $45 $50 $65 $65 $65 $80 $80
Pharmacy7 $10/ $30/ $90/ 50% $10/ $30/
$90/ 50%
$15/ $45/
$100/ 50%
$15/ $45/
$100/ 50%
$15/ $45/
$100/ 50%
$25/ $50/
50%/ 50%
$25/ $50/
50%/ 50%

Health Net Health Plan of Oregon, Inc. (Health Net) CommunityCare 3T plans are available to Oregon groups located in Multnomah, Clackamas, Washington, Clatsop, Columbia, and Tillamook counties.

CommunityCare 3T gives members three levels of access and coverage. They can use the CommunityCare network, other Health Net contracted providers, or a non-network provider. Services received via the CommunityCare network are covered at a higher, in-network benefit while out-of-network services are reimbursed at a percentage of the maximum allowable amount.

CommunityCare 3T Member(s) Responsibility
Plan Name 15-500-1-3000DX 25-750-2-3000DX 25-1000-2-7900DX 25-2000-2-7900DX 25-3500-2-7900DX 40-3000-3-8150ES 40-4500-3-8150ES
Metal Level Platinum Platinum Gold Gold Gold Silver Silver
Deductible2
(single/family)
$500/
$1,000
$750/
$1,500
$1,000/
$2,000
$2,000/
$4,000
$3,500/
$7,000
$3,000/
$6,000
$4,500/
$9,000
Out-of-Pocket maximum3
(single/family)
$3,000/
$6,000
$3,000/
$6,000
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
$8,150/
$16,300
$8,150/
$16,300
Office visit (PCP/Spec.) $15/$45 $20/$50 $25/$65 $25/$65 $25/$65 $40/$80 $40/$80
Coinsurance4 10%/50% 20%/50%
20%/50%/
20%/50%/
20%/50%
30%/50%
30%/50%
Lab / x-ray  $15 $20 $25 $25 $25 30% 30%
CT/MRI/PET/SPEC 10% 20% 20% 20% 20% 30% 30%
Inpatient Hospital 10% 20% 20% 20% 20% 30% 30%
Outpatient Surgery (ASC / Hospital) 5%/10% 10%/20% 10%/20% 10%/20% 10%/20% 20%/30% 20%/30%
Emergency $250+20% $250+20%
$250+20%
$250+20%
$250+20%
30% 30%
Urgent Care $45 $50 $65 $65 $65 $80 $80
Pharmacy7 $10/ $30/ $90/ 50% $10/ $30/
$90/ 50%
$15/ $45/
$100/ 50%
$15/ $45/
$100/ 50%
$15/ $45/
$100/ 50%
$25/ $50/
50%/ 50%
$25/ $50/
50%/ 50%

Participation Guidelines

Access to Health Net's Enhanced Choice portfolio requires the following guidelines:

1-5 Eligible Employees
+
66% Employee Participation Minimum
+
Employer Pays Minimum of 50% of Base Plan Monthly
=
Access to Health Net's Enhanced Choice Portfolio

6-50 Eligible Employees
+
50% Employee Participation Minimum
+
Employer Pays Minimum of 50% of Base Plan Monthly
=
Access to Health Net's Enhanced Choice Portfolio


1 All medical plans include pediatric vision coverage. Pediatric dental coverage must be purchased for dependents under 19 years of age through Health Net or another carrier. Pediatric dental is not available with the Health Net of Oregon Standard medical plans.
2 The specified deductible must be met each calendar year (January 1 through December 31) before Health Net pays any claims.
3 The annual out-of-pocket maximum includes the annual deductible, copayments and coinsurance. After the out-of-pocket maximum is reached in a calendar year, we will pay the covered services during the rest of that calendar year at 100% of our contract rates for participating provider services and at 100% of the maximum allowable amount (MAA) for out-of-network (OON) services. Members are still responsible for OON-billed charges that exceed MAA.
4 Coinsurance is subject to the annual deductible.
5 Deductible is waived.
6 After deductible.
7 Prescription drug tiers are Tier 1: Generic; Tier 2: Brand Preferred; Tier 3: Non-Preferred; SP: Specialty. Retail pharmacy – members may receive a 90-day fill at a retail pharmacy; one copayment coinsurance applies per 30-day supply. Tier 1, 2 or 3 prescription drugs may apply. Deductible waived unless otherwise noted. MAC A applies. Essential Rx Drug List – A listing of preferred drugs and their corresponding benefit levels is shown on the Health Net Essential Rx Drug List (EDL). Log in as a Health Net member to view Oregon Essential RX Drug List.
8 All benefits including office visit copay, pharmacy, and alternative care are after deductible.
9 All copayments accumulate to the medical out-of-pocket maximum.
10 Benefits not available on Standard Plans.
11 In-and-out-of-network visits combined. 

This information is intended to be used for marketing purposes only and presents general information. Please refer to the Benefit Schedule and Agreement for details, limitations, exclusions, and other terms and conditions of coverage.