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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 coverage1 and Teladoc®, a new vendor providing telehealth services.2


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 P20-500-2-4000LX P20-750-2-4000LX
Metal Level Platinum Platinum Platinum
Deductible3
(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
$20/$40 $20/$40
Coinsurance4 10%/50%
20%/50%
20%/50%
Lab / x-ray
(deductible waived)
10%/Yes
20%/Yes 20%/Yes
CT/ MRI/ PET/ SPEC (deductible waived) 10%/Yes
20%/Yes 20%/Yes
Emergency $250+10%
ded. waived
$250+20%
ded. waived
$250+20%
ded. waived
Pharmacy5 $10/$30/
$90/50%
$10/$30/
$90/50%
$10/$30/
$90/50%

 

PPO Gold Member(s) Responsibility
Plan Name P50-0-
5-5000
P20-
500-3-
7900DX
P20- 1000-2-
7900DX
P30- 1500-2-
7900DX
P20-2000-2-
7900DX
P20- 2500-3- 7900DX P30-3500-3- 7900DX
Metal Level Gold Gold Gold Gold Gold Gold Gold
Deductible3
(single/
family)
$0/$0 $500/
$1,000
$1,000/
$2,000
$1,500/
$3,000
$2,000/
$4,000
$2,500/
$5,000
$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
Office visit (PCP/Spec.) 50%/50%
$20/$40
$20/$40 $30/$60 $20/$40 $20/$40 $30/$60
Coinsurance4 50%/50%
30%/50%
20%/50%
20%/50%
20%/50%
30%/50%
30%/50%
Lab / x-ray (deductible waived) 50%/No
30%/Yes
$20/Yes 20%/Yes 20%/Yes 30%/Yes 30%/Yes
CT/ MRI/
PET/ SPEC (deductible waived)
50%/No
30%/No
20%/No 20%/No 20%/No 30%/No 30%/No
Emergency 50%

$250+30%
ded. waived
$250+20%
ded. waived
$250+20%
ded. waived
$250+ 20%
ded. waived
$250+30%
ded. waived
$250+ 30%
ded. waived

Pharmacy5
$15/$45/
$90/50%
$15/$45/
$90/50%
$15/$45/
$90/50%
$15/$45/
$90/50%
$20/$45/
$90/50%
$20/$45/
$90/50%
$20/$45/
$90/50%

 

PPO Silver/Bronze Member(s) Responsibility
Plan Name P40-3000-3-8150ES P45-3500-5-8150ES P40-4000-3-8150ES P45-5000-5-8150ES P75-5000-5-8150ES P7350-0-
7350ES
Metal Level Silver Silver Silver Silver Bronze Bronze
Deductible3
(single/family)
$3,000/
$6,000
$3,500/
$7,000
$4,000/
$8,000
$5,000/
$10,000
$5,000/
$10,000
$7,350/
$14,700
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
$7,350/
$14,700
Office visit (PCP/Spec.) $40/$80 $45/$90 $40/$80 $45/$90 $75 after
ded./$120
after ded.
0%/0%
Coinsurance4 30%/50% 50%/50% 30%/50% 50%/50%
50%/50% 0%/50%
Lab / x-ray (deductible waived) 30%/No 50%/No 30%/No 50%/No
50%/No 0%/No
CT/ MRI/ PET/ SPEC (deductible waived) 30%/No 50%/No 30%/No 50%/No
50%/No 0%/No
Emergency 30% 50% 30% 50%
50% 0%
Pharmacy5 $20/$50/
50%/50%
$25/$50/
50%/50%
$25/$50/
50%/50%
$25/$50
50%/50%
$25/30% 
after ded.
/50% after ded.
/50% after ded.
0% after ded.

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)6 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 HD6550-0-6550ES
Metal Level Silver Bronze
Deductible3 (single/family) $2,800/
$5,600
$6,550/
$13,100
Out-of-Pocket maximum3 (single/family) $5,500/
$11,000
$6,550/
$13,100
Office visit (PCP/Spec.) 20%/20% 0%/0%
Coinsurance4 20%/50% 0%/50%
Lab / x-ray (deductible waived) 20%/No 0%/No
CT/ MRI/ PET/ SPEC (deductible waived) 20%/No 0%/No
Emergency 20%
0%
Pharmacy5 20% after ded./
20% after ded./
20% after ded./
50% after ded.
0% after ded.

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
Deductible3
(single/family)
$1,000/
$2,000
$3,550/
$7,100
$7,900/
$15,800
Out-of-Pocket maximum3
(single/family)
$7,300/
$14,600
$8,150/
$16,300
$7,900/
$15,800
Office visit (PCP/Spec.) $20/$40 $40/$80 $45/$90
Coinsurance4 20%/50% 30%/50% 0%/50%
Lab / x-ray (deductible waived) 20%/No 30%/No 0%/No
CT/ MRI/ PET/ SPEC (deductible waived) 20%/No 30%/No 0%/No
Emergency 20%
30% 0%
Pharmacy5 $10/$30/50%/50% ($500 per script cap) $15/$60/50%/50% $15/0% after ded./
0% after ded.

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 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 Gold Gold Gold Silver Silver
Deductible3
(single/family)
$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
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
$8,150/
$16,300
$8,150/
$16,300
Office visit (PCP/Spec.) $25/$55 $25/$65 $25/$65 $25/$65 $40/$80 $40/$80
Coinsurance4 20% 20% 20% 20% 30% 30%
Lab / x-ray (deductible waived) 20%/Yes 20%/Yes 20%/Yes 20%/Yes 30%/No 30%/No
CT/ MRI/ PET/ SPEC (deductible waived) 20%/No 20%/No 20%/No 20%/No 30%/No 30%/No
Emergency $250+20%
ded. waived
$250+20%
ded. waived
$250+20%
ded. waived
$250+20%
ded. waived
30% 30%
Pharmacy5 $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 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 Gold Gold Gold Silver Silver
Deductible3
(single/family)
$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
$7,900/
$15,800
$7,900/
$15,800
$7,900/
$15,800
$8,150/
$16,300
$8,150/
$16,300
Office visit (PCP/Spec.) $25/$55 $25/$65 $25/$65 $25/$65 $40/$80 $40/$80
Coinsurance4 20%/50%/
50%
20%/50%/
50%
20%/50%/
50%
20%/50%/
50%
30%/50%/
50%
30%/50%/
50%
Lab / x-ray (deductible waived) 20%/Yes 20%/Yes 20%/Yes 20%/Yes 30%/No 30%/No
CT/ MRI/ PET/ SPEC (deductible waived) 20%/No 20%/No 20%/No 20%/No 30%/No 30%/No
Emergency $250+20%
ded. waived
$250+20%
ded. waived
$250+20%
ded. waived
$250+20%
ded. waived
30% 30%
Pharmacy5 $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 Telemedical services include coverage provided by Teladoc. Teladoc provides supplemental telehealth services in addition to the mandated telemedicine services for medical, mental disorders and chemical dependency conditions. Teladoc services are not intended to replace services from your physician. Teladoc consultation services do not cover specialist services; and prescriptions for substances controlled by the DEA, non-therapeutic drugs or certain other drugs which may be harmful because of potential abuse. Teladoc is covered at $0, deductible waived (except HDHP - $0, after deductible).
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 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.
6 All benefits including pharmacy and alternative care are after deductible.

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.