












Cascade Mountains
CITIES: Brightwood, Camp
Sherman,
Cascade Locks, Cascadia, Chemult,
Chiloquin, Crescent, Crescent Lake, Detroit, Diamond Lake, Drew,
Estacada, Fort Klamath, Gates, Gilchrist, Government Camp, Idanha,
Klamath Agency, La Pine, Lakeview, McKenzie Bridge, Mill City, North
Umpqua, Oakridge, Prospect, Rhododendron, Sandy,
Sisters,
Sunriver, Warm Springs,
Welches, Westfir, Zigzag
AREAS: Crater Lake National Park, Deshutes National Forest,
Fremont National Forest, Mount Hood National Forest, Rogue River
National Forest, The Three Sisters, Umpqua National Forest, Willamette
National Forest, Winema National Forest
Central Oregon
CITIES: Antelope,
Arlington,
Bend, Brothers, Condon, Culver, Dufur,
Fossil, Grass Valley, Hampton, Lonerock,
Madras, Maupin, Metolius, Mitchell, Moro,
Mosier, Paulina, Post, Prineville,
Redmond, Rowena,
Rufus, Shaniko, Spray,
The Dalles, Wasco
Northeast Oregon
CITIES: Adams, Arlington,
Athena,
Baker City, Boardman, Canyon City, Condon,
Cove, Dayville, Echo, Elgin,
Enterprise, Fossil, Greenhorn, Haines, Halfway,
Heppner, Hermiston, Huntington, Imbler, Imnaha, Irrigon, Island City, John Day,
Joseph,
La Grande, Lexington, Long Creek, Lostine,
Medical Springs, Milton-Freewater, Monument, Mt Vernon, North Powder, Oxbow,
Pendleton, Pilot Rock, Prairie City,
Richland, Seneca, Summerville, Sumpter, Ukiah, Umatilla, Union, Unity,
Wallowa, Weston
AREAS:
Hell's Canyon
Oregon Coast
North Coast
Astoria, Bay City, Beaver,
Cannon Beach,
Garibaldi,
Gearhart, Hebo,
Nehalem,
Manzanita, Neahkahnie, Oceanside,
Pacific City,
Rockaway Beach,
Seaside,
Tillamook,
Warrenton,
Wheeler
Central Coast
Depoe Bay,
Dunes City,
Florence,
Gleneden Beach,
Lincoln City, Mapleton,
Newport, Otter Rock, Reedsport, Seal Rock,
Siletz,
Toledo,
Waldport,
Winchester Bay,
Yachats
South Coast
Agness,
Bandon,
Brookings,
Charleston,
Coos Bay, Coquille,
Gold Beach,
Lakeside,
Myrtle Point,
North Bend,
Port Orford, Powers, Wedderburn
Portland and Vicinity
Banks, Barlow,
Beaverton, Camas, Canby,
Clackamas, Clatskanie, Columbia City,
Cornelius,
Forest Grove, Gaston,
Gresham, Happy Valley,
Hillsboro,
Lake Oswego, Marquam,
Milwaukie, Molalla, North Plains,
Oregon City,
Portland, Rainier, Sandy, Scappoose, St.
Helens,
Tigard, Troutdale,
Tualatin, Vernonia, West Linn,
Wilsonville
Southeast Oregon
Adel, Adrian, Burns, Diamond, Drewsey,
Frenchglen, Hines, Jordan Valley, Juntura, Lakeview, Nyssa,
Ontario, Plush, Vale
Southern Oregon
CITIES:
Ashland, Butte Falls, Cave Junction,
Canyonville, Central Point, Dillard, Drain, Eagle Point, Elkton, Glendale,
Glide, Gold Hill,
Grants Pass, Jacksonville, Klamath Falls, Malin,
Medford,
Merlin, Myrtle Creek, Oakland, Phoenix,
Prospect, Riddle, Rouge River, Roseburg, Shady Cove, Sutherlin, Talent,
Umpqua, White City, Winchester, Winston, Wolf Creek, Yoncalla
AREAS: Applegate Valley, Illinois Valley
Willamette Valley
Albany, Alsea, Amity, Aumsville,
Aurora, Brooks,
Brownsville, Canby, Canyonville, Carlton,
Corvallis, Coburg, Cottage Grove, Creswell,
Culp Creek, Dallas, Dayton, Detroit, Donald,
Dundee,
Eugene, Falls City, Gates, Gervais, Halsey,
Harrisburg, Independence, Jefferson, Junction City, Keizer, Lebanon, Lowell,
Lyons,
McMinnville, Mill City, Millersburg, Mt.Angel,
Molalla, Monmouth, Newberg, Oakridge, Oregon City, Philomath,
Salem, Scio, Scott Mills, Sheridan,
Silverton, Sodaville, Springfield, Stayton, St. Paul, Sublimity, Sweet Home,
Tangerit, Turner, Veneta, Walterville, Waterloo, Willamina, Woodburn, Yamhill
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Pacificsource health plans of oregon 2015
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Provider Directory
1-800-624-6052 |
Use the Provider Directory to find
doctors and facilities, use "Preferred PSN" as the network, and enter
specific search requirements
|
2015 Individual and Family
Medical and Dental Policy Enrollment Form |
First Health Network - Outside Oregon |
2015 Oregon Individual and Family Plans
The information on this page is for plans beginning
January 1, 2015. 2015
plans are pending State and CMS approval.
PSN Plans
-
Rates:
-
Area 1: Clackamas, Multnomah, Washington, and
Yamhill
-
Area 2: Benton, Lane, and Linn
-
Area 3: Marion and Polk
-
Area 4: Deschutes, Klamath, and Lake
-
Area 5: Clatsop, Columbia, Coos, Curry, Lincoln,
and Tillamook
-
Area 6: Baker, Crook, Gilliam, Grant, Harney, Hood
River, Jefferson, Malheur, Morrow, Sherman, Umatilla,
Union, Wallowa, Wasco, and Wheeler
-
Area 7: Douglas, Jackson, and Josephine
-
Brochure: PSN
Plans for Oregon Individuals and Families
-
Enrollment
Form: 2015
Individual and Family Medical and Dental Policy
Enrollment Form
|
Plan |
Deductible |
Out-of-pocket Limit |
Co-insurance |
Plan
Details |
|
Balance Bronze PSN 6600 |
$6,600 / $13,200
|
$6,600 / $13,200
|
0%
|
|
|
Value Bronze PSN 6250 |
$6,250 / $12,500
|
$6,250 / $12,500
|
0%
|
|
|
Value Bronze PSN 3000 |
$3,000 / $6,000
|
$6,450 / $12,900
|
50%
|
|
|
Standard Bronze PSN |
$5,000 / $10,000
|
$6,350 / $12,700
|
50%
|
|
|
|
Balance Silver PSN 2500 AC |
$2,500 / $5,000
|
$6,450 / $12,900
|
30%
|
|
|
Balance Silver PSN 1500 AC |
$1,500 / $3,000
|
$6,450 / $12,900
|
30%
|
|
|
Value Silver PSN 3600 |
$3,600 / $7,200
|
$3,600 / $7,200
|
0%
|
|
|
Value Silver PSN 3000 |
$3,000 / $6,000
|
$3,000 / $6,000
|
0%
|
|
|
Standard Silver PSN |
$2,500 / $5,000
|
$6,350 / $12,700
|
30%
|
|
|
|
Standard Gold PSN |
$1,000 / $2,000
|
$6,350 / $12,700
|
10%
|
|
|
|
Catastrophic PSN |
$6,600 / $13,200
|
$6,600 / $13,200
|
0%
|
|
|
SmartChoice Plans
-
Rates:
-
Area 2: Benton, Lane, and Linn
-
Area 3: Marion and Polk
-
Area 4: Deschutes, Klamath, and Lake
-
Area 5: Clatsop, Columbia, Coos, Curry, Lincoln,
and Tillamook
-
Area 6: Baker, Crook, Gilliam, Grant, Harney, Hood
River, Jefferson, Malheur, Morrow, Sherman, Umatilla,
Union, Wallowa, Wasco, and Wheeler
-
Area 7: Douglas, Jackson, and Josephine
-
Brochure: SmartChoice
Plans for Oregon Individuals and Families
-
Enrollment
Form: 2015
Individual and Family Medical and Dental Policy
Enrollment Form
|
Plan |
Deductible |
Out-of-pocket Limit |
Co-insurance |
Plan
Details |
|
Balance Bronze 6600 |
$6,600 / $13,200
|
$6,600 / $13,200
|
0%
|
|
|
Value Bronze 6250 |
$6,250 / $12,500
|
$6,250 / $12,500
|
0%
|
|
|
Value Bronze 3000 |
$3,000 / $6,000
|
$6,450 / $12,900
|
50%
|
|
|
Standard Bronze |
$5,000 / $10,000
|
$6,350 / $12,700
|
50%
|
|
|
|
Balance Silver 2500 AC |
$2,500 / $5,000
|
$6,450 / $12,900
|
30%
|
|
|
Balance Silver 1500 AC |
$1,500 / $3,000
|
$6,450 / $12,900
|
30%
|
|
|
Value Silver 3600 |
$3,600 / $7,200
|
$3,600 / $7,200
|
0%
|
|
|
Value Silver 3000 |
$3,000 / $6,000
|
$3,000 / $6,000
|
0%
|
|
|
Standard Silver |
$2,500 / $5,000
|
$6,350 / $12,700
|
30%
|
|
|
|
Standard Gold |
$1,000 / $2,000
|
$6,350 / $12,700
|
10%
|
|
|
|
Catastrophic |
$6,600 / $13,200
|
$6,600 / $13,200
|
0%
|
|
|
SmartHealth Plans
-
Rates:
-
Area 1: Clackamas, Multnomah, Washington, and
Yamhill
-
Area 6: Baker, Crook, Gilliam, Grant, Harney, Hood
River, Jefferson, Malheur, Morrow, Sherman, Umatilla,
Union, Wallowa, Wasco, and Wheeler
-
Brochure: SmartHealth
Plans for Oregon Individuals and Families
-
Enrollment
Form: 2015
Individual and Family Medical and Dental Policy
Enrollment Form
|
Plan |
Deductible |
Out-of-pocket Limit |
Co-insurance |
Plan
Details |
|
Balance Bronze 6600 |
$6,600 / $13,200
|
$6,600 / $13,200
|
0%
|
|
|
Value Bronze 6250 |
$6,250 / $12,500
|
$6,250 / $12,500
|
0%
|
|
|
Value Bronze 3000 |
$3,000 / $6,000
|
$6,450 / $12,900
|
50%
|
|
|
Standard Bronze |
$5,000 / $10,000
|
$6,350 / $12,700
|
50%
|
|
|
|
Balance Silver 2500 AC |
$2,500 / $5,000
|
$6,450 / $12,900
|
30%
|
|
|
Balance Silver 1500 AC |
$1,500 / $3,000
|
$6,450 / $12,900
|
30%
|
|
|
Value Silver 3600 |
$3,600 / $7,200
|
$3,600 / $7,200
|
0%
|
|
|
Value Silver 3000 |
$3,000 / $6,000
|
$3,000 / $6,000
|
0%
|
|
|
Standard Silver |
$2,500 / $5,000
|
$6,350 / $12,700
|
30%
|
|
|
|
Standard Gold |
$1,000 / $2,000
|
$6,350 / $12,700
|
10%
|
|
|
|
Catastrophic |
$6,600 / $13,200
|
$6,600 / $13,200
|
0%
|
|
|
Dental Plans
|
Dental Advanatage Essentials Core* |
|
Dental Advantage 0/20/50 |
|
Kids Dental Advantage 0/20/50 |
*Available only
through HealthCare.gov.
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2014 Oregon Individual and Family Plans Available Direct
from PacificSource
A Real Person Will Answer give
me a call: Doug Ellsworth 503-922-2903
The information on this page is for plans beginning January
1, 2014.
View 2013 information.
Download our
Guide to PacificSource Individual and
Family Plans for Oregon Residents.
PacificSource Application "Direct"
/
PacificSource Dental Application
"Direct"
Rates
Area 1 Rates: |
Clackamas,
Multnomah, Washington, and Yamhill |
Area 2 Rates: |
Benton, Lane, and Linn Counties |
Area 3 Rates: |
Marion and Polk
Counties |
Area 4 Rates: |
Deschutes, Klamath, and Lake Counties |
Area 5 Rates: |
Clatsop, Columbia,
Coos, Curry, Lincoln, and Tillamook Counties |
Area 6 Rates: |
Baker, Crook, Gilliam, Grant, Harney,
Hood River, Jefferson, Morrow, Malheur, Sherman, Umatilla,
Union, Wallowa, Wasco, and Wheeler Counties |
Area 7 Rates: |
Douglas, Jackson, and
Josephine Counties |
Dental Rates:
|
Statewide |
Plans
PSN
|
Balance Bronze PSN 6350
(AC) |
|
|
Value Bronze PSN 6250 |
|
|
Value Bronze PSN 3000 |
|
|
Oregon Standard Bronze PSN Plan |
|
|
|
Balance Silver PSN 2500 (AC) |
|
|
Value Silver PSN 3000 |
|
|
Oregon Standard Silver PSN Plan |
|
|
SmartHealth
|
SmartHealth Balance
Bronze 6350 (AC) |
|
|
SmartHealth Value Bronze 6250 |
|
|
SmartHealth Value Bronze 3000 |
|
|
Oregon Standard Bronze SHN Plan |
|
|
|
SmartHealth Balance Silver 2500 (AC) |
|
|
SmartHealth Balance Silver 1500 (AC) |
|
|
SmartHealth Value Silver 3000 |
|
|
Oregon Standard Silver SHN Plan |
|
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Application
Elect Plans and Rates
Rates for all plans below 2013
Download our at-a-glance Elect
product brochure (3 MB).
The Elect sample summary of benefits and coverage
(SBC) documents below can also help you compare plans:
Choose from five Elect plans:
- Elect Premiere
is our most expansive coverage. You'll pay just a $25
co-pay for office visits, acupuncture, naturopathic, and
chiropractic care. Elect Premiere plans also include vision
care. Annual deductibles range from $1,000 to $10,000.
- Elect Preferred
is comprehensive coverage. It offers $30 co-pays for
office visits and chiropractic care. It also offers an accident
benefit, urgent care, and prescription drug coverage. Most other
in-network services are covered at 70% after the annual
deductible. Annual deductibles range from $500 to $10,000.
- Elect Balance
offers extensive coverage, at an affordable price. It offers $35
co-pays for office visits, acupuncture, and chiropractic
care. Annual deductibles range from $2,500 to $7,500.
- Elect Value Option is
low cost, catastrophic coverage. It offers peace of mind with
basic coverage for a low monthly rate. Most in-network services
are covered at 60% after the annual deductible; prescription
drugs are covered at 50% after the deductible. Elect Value
deductibles range from $2,500 to $10,000.
- Elect HSA plans
are high-deductible health plans eligible for combination with a
health savings account (HSA). Learn more about
HSAs and
consumer-directed health plans.
Elect HSA plan deductibles range from $1,500 to $5,000. Most
other in-network services are covered at 70% after the annual
deductible.
Elect plan highlights at a glance:
- Coverage for maternity, illness and
injury, and prescription drugs
- First-dollar accident benefit
- On-the-job coverage if you are
self-employed
- No lifetime maximum benefit
- Preventive care 100% covered for
participating providers
- Some plans cover alternative
practitioner services, and vision care
-
No-cost extras
to help you save money and stay healthy
- Your choice of providers; no need for
referrals from a primary care practitioner
- All provide the highest level of
benefits if you choose participating providers, and reduced
benefits for nonparticipating providers.
- An extensive network of participating
providers within Oregon, plus
in-network coverage throughout
the U.S.
- You'll receive the highest level of benefits by using
participating providers.
- Participating providers accept benefits paid under the
policy as full payment, and will not bill you for the balance
(other than for deductibles, co-insurance, or co-payments).
Find an Oregon Individual Health Plan
Our Elect product line includes comprehensive health plans for
Oregonians who aren't covered by Medicare. If you're
self-employed, you are eligible for on-the-job health coverage at
no extra cost. You are not required to choose a primary care
practitioner or seek referrals for specialist care. Applications
for these policies are health underwritten, and coverage is
offered or declined based on your health. Watch our video to learn
more.
Consumer-Directed Health Plans 101:
2. Health Savings Accounts (HSAs)
An HSA is a true bank account into which you deposit money to
be used for your future healthcare expenses. Your HSA
contributions can be deducted from your paycheck before taxes, or
you can contribute your own money and deduct your contributions
when you file your income taxes. Your employer or family members
can also contribute to your HSA. No matter who contributes, the
money is yours and will stay with you even if you change jobs or
retire. The money in your HSA earns interest just like a regular
bank account.
You’ll need a qualifying “high-deductible health plan”—also
known as an HDHP—to go with your HSA. HDHPs must have a deductible
of $1,150 or more, but sometimes preventive care is exempt from
that deductible. The great thing about HSAs is that you can use
the money in your account to pay those deductible expenses. Any
unused money in your HSA carries over from year to year just like
a regular savings account, so you can save your money for future
medical expenses.
HSAs are available from most banks, credit unions, and other
financial institutions. They come with checkbooks and debit cards
you can use to access your account funds. Your bank won’t check to
make sure you only use HSA funds for eligible healthcare expenses.
You’re responsible for keeping those receipts or other
documentation to prove that you used your HSA appropriately in
case of an IRS audit.
For more detail on HSA regulations, visit the U.S. Treasury’s
HSA FAQ site.
HSA highlights:
- Your, your employer, or your family
members can contribute to your HSA.
- You own your account and all the money
in it, no matter who contributed.
- Money you or your employer deposit is
tax deductible, earns tax-free interest, and can build from year
to year.
- You can withdraw funds to pay for
medical expenses any time without taxes or penalties.
- You can withdraw funds for nonmedical
use subject to taxes and an IRS penalty.
- HSAs are regulated by the federal
government.
- You must have a qualifying
high-deductible health plan (HDHP) to contribute to your HSA. If
your HDHP coverage ends, the HSA is still yours. You can spend
those funds on qualifying healthcare expenses, but can’t make
additional contributions without an HDHP.
Next, we’ll cover HRAs.
Ready to find a consumer-directed health
plan?
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Health
Benefit Solution, Inc.
The focus of this website is to
provide consumers a simple, and professional environment when
looking for Affordable, and Low Cost Health Insurance.
Licensed Health Insurance Agents are available and will take the
time to answer all your questions, and help find the Health Plan
that best meets the needs of the Individual, Family, or Small
Business.
Health Insurance Benefits are
always changing, and health insurance companies are providing more
options that benefit the consumer. Alternative, or Holistic
health care is now offered through many of the health insurance
companies. You can now see your Naturopathic Physician, and be
covered under the doctor office co-pay, and have unlimited visits.
Chiropractic, and Acupuncture are also included as standard health
care benefits.
If you are looking for Dental and
Vision benefits included within the health plan, we can help you
select the Health Insurance Company that will meet your needs.
Health Benefit Solution, Inc is
licensed through the Oregon Insurance Division, and has contracted
with most all the major health insurance companies to provide the
consumer with choice and options when looking for the plan that
meets the life style and needs of the insured.
PacificSource is an independent, not-for-profit health plan
serving the Pacific Northwest.
Founded in 1933,
PacificSource provides medical and dental benefits to more than 4,000
employers and covers more than 151,000 people with its group and
individual health insurance plans. It also provides self-funded
employee benefit plans, flexible spending accounts, HRAs, and COBRA
administration services through its subsidiaries,
Manley Services and
Select Benefit Administrators.
Together, PacificSource and its subsidiaries employ 324 people.
At PacificSource, we're committed to
helping people get the healthcare they need. We offer group insurance
clients a wide range of medical, dental, prescription drug, and vision
benefits. We also meet the needs of individuals and families with
comprehensive medical plans, portability policies, and Medicare
supplement policies.
At PacificSource, we're known for
taking good care of people. Members can call our toll-free number to
speak with a customer service representative for friendly,
professional benefits and claims assistance. Our client service
representatives are available for on-site visits and benefit meetings
with our group insurance clients. And we strive to provide all our
customers with the information and tools they need to make informed
healthcare decisions. In everything we do, we will always maintain the
friendly, personal manner which lets you know that serving you is our
pleasure.
PacificSource Community
Giving Program Helps Build "Healthy Communities"
At PacificSource, we
strive to improve the communities we serve, with a particular emphasis
on increasing access to healthcare services. But we know that the
health of a community relates to more than just healthcare – it also
relates to the support network available to those who require
assistance in making healthy lifestyle choices or providing for their
basic needs.
As members of the
communities in which we do business, PacificSource seeks to promote
the capacity of individuals, families, and communities to increase
healthy behaviors and lifestyle choices and to provide a safe and
nurturing environment for children to develop into healthy adults.
Healthy
Communities, our community giving program, is designed to benefit
nonprofit organizations that serve people in the communities where we
do business. Through this program, we provide financial support,
in-kind donations, and employee volunteer assistance to organizations
working toward some or all of the following goals:
-
To
educate and empower individuals and families to adopt healthy
behaviors and lifestyles,
-
To
sponsor safe, healthy, educational, and fun family-oriented
activities, and
-
To
build local capacity to improve the health of the community.
Our Healthy Communities
program is administered by an employee committee charged with
reviewing requests and making recommendations on PacificSource’s
involvement. We are pleased to consider requests from organizations
that:
-
Meet the IRS’s
qualifications for nonprofit charitable organizations;
-
Are not arts, political, or
faith-specific/religious causes; and
-
Earmark the funds
to benefit people in the communities we serve.
The committee
evaluates requests based on the following criteria:
-
Match
with the “Healthy Communities” program mission
-
PacificSource’s past history with the organization
-
Opportunity for recurring or long-term involvement
-
Opportunity for personal involvement by our employees
-
Budget
availability by region/market
-
Value
of public awareness opportunities or name recognition for
PacificSource
Sources for Information on
Hospital Quality:
First Health Provider Directory
Search for participating First Health physicians, hospitals, and
facilities outside Oregon, western Idaho, and southwest Washington.
Caremark® Web Site
The Caremark site offers health and wellness information plus tools to
manage your prescriptions, look up drug coverage and pricing, and
locate a participating pharmacy.
PacificSource PDL (Preferred Drug List)
This list of
preferred brand name medications is updated monthly. If your benefits
include prescription drug coverage, the drugs on this list are
available for your plan's Tier 2 (Preferred) copayment.
Caremark® Prescribing Guide
You'll use this list of preferred medications if you're covered under
a prescription drug plan that's based on a formulary,
and not on the PDL or VDL.
Mail Order Prescription Drug Service
PacificSource members with mail order prescription drug benefits can
order prescription refills from
Walgreens Mail
Service or
Wellpartner Pharmacy right over the Internet.
Oregon Health Plan
Find information on eligibility requirements and applying for coverage
under the state-sponsored Oregon Health Plan.
Oregon
Insurance Division
This is the Web
site of the state agency that oversees the insurance industry in
Oregon.
Healthfinder
The site features links to more than 1,250 government and other
consumer health resources on the Web.
PacificSource Grievance & Appeal
Information
This publication includes common questions
and answers about our member grievance and appeal process.
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