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 Standard 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)

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)

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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)