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
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
Broker Portfolio Guide
Plan Portfolio Desktopper
Employer Group Renewal Guide
Presentation Folder
Note: For example only. Folders can be ordered on CustomPoint
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
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
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
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
Alternative Care
Pediatric Dental and Vision
Vision
- Preferred Plan 1025-2 – English (PDF)
- Preferred Plan 1025-3 – English (PDF)
- Elite 1010-1 – English (PDF)
Dental
Alternative Care
Pediatric Dental and Vision
Vision
- Preferred Plan 1025-2 – English (PDF)
- Preferred Plan 1025-3 – English (PDF)
- Elite 1010-1 – English (PDF)
Dental
SBC Distribution Information
The PDF below provides detailed instructions for distribution and reproduction of the Summary of Benefits and Coverage (SBC) document, as required under the Affordable Care Act.
CommunityCare
Additional Tools
- Health Net Value-Add Programs Flyer (PDF)
- Prior-Carrier Deductible Credit Flyer (PDF)
- Teladoc Member FAQs (PDF)
- You've Got Teladoc Health (PDF)
- Teladoc – Your Path Toward Mental Well-Being (PDF)
- EFT Set Up Instructions (PDF)
- How To Read Your Commission Statement (PDF)
- Member Handbook – English (PDF)
- Member Handbook – En Español (Spanish) (PDF)
- Same Day Care (PDF)
- Coordination of Benefits for Members (PDF)
- Generic vs Brand-Name Drugs Information (PDF)
- Employer Online Enrollment and Billing (PDF)
- First Health Network FAQs (PDF)
- Dental Website Overview (PDF)
- Vision Website Overview (PDF)
- Employer Portal Registration (PDF)
- Behavioral Health FAQs (PDF)
- Health Net Website Flyer (PDF)
- Find a Provider Flyer (PDF)
Uniform Glossary of Health Coverage and Medical Terms
Health insurance companies and group health plans are required to make available a uniform glossary of health coverage and medical terms commonly used in plan documents. The Uniform Glossary is meant to help the consumer understand some of the most common language used in health insurance documents. Please log in to request a hard copy of the document by mail.
- Uniform Glossary of Health Coverage and Medical Terms – English (PDF)
- Uniform Glossary of Health Coverage and Medical Terms – En Español (Spanish) (PDF)
- Uniform Glossary of Health Coverage and Medical Terms – Chinese (PDF)
- Uniform Glossary of Health Coverage and Medical Terms – Navajo (PDF)
- Uniform Glossary of Health Coverage and Medical Terms – Korean (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.
- 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)