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 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 on the Oregon State Standard medical plans.1
Plan Details
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.
| 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 (in-network/out-of-network) | 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% |
| Plan Name | P50-0- 5-5000 | P0-1500-4-7900DX | P0-3500-4-7900DX | 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 | Gold | Gold |
| Deductible2 (Single/ Family) | $0/$0 | $1,500/ $3,000 | $3,500/ $7,000 | $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 | $7,900/ $15,800 | $7,900/ $15,800 |
| Office Visit (PCP/Spec.) | 50%/50% | $0/$50 | $0/$50 | $20/$40 | $20/$40 | $30/$60 | $20/$40 | $20/$40 | $30/$60 |
| Coinsurance4 | 50%/50% | 40%/50% | 40%/50% | 30%/50% | 20%/50% | 20%/50% | 20%/50% | 30%/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% | 20% | 30% | 30% |
| Inpatient Hospital | 50% | 40% | 40% | 30% | 20% | 20% | 20% | 30% | 30% |
| Outpatient Hospital | 40%/50% | 30%/40% | 30%/40% | 20%/30% | 10%/20% | 10%/20% | 10%/20% | 20%/30% | 20%/30% |
| Emergency | 50% | 40% | 40% | $250+30% | $250+20% | $250+20% | $250+ 20% | $250+30% | $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% | $15/$45/ $90/50% | $20/$45/ $90/50% | $20/$45/ $90/50% | $20/$45/ $90/50% |
| Plan Name | P40-3000-3-8150ES | P45-3500-5-8150ES | P40-4000-3-8150ES | P20-5000-5-8150DX | P45-5000-5-8150ES | P8250-0- 8250ES |
|---|---|---|---|---|---|---|
| Metal Level | Silver | Silver | Silver | Silver | Silver | Bronze |
| Deductible2 (Single/Family) | $3,000/ $6,000 | $3,500/ $7,000 | $4,000/ $8,000 | $5,000/ $10,000 | $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.) | $40/$80 | $45/$90 | $40/$80 | $20/$50 | $45/$90 | 0%/0% |
| Coinsurance4 | 30%/50% | 50%/50% | 30%/50% | 50%/50% | 50%/50% | 0%/50% |
| Lab / X-Ray | 30% | 50% | 30% | $20 | 50% | 0% |
| CT/MRI/PET/SPEC | 30% | 50% | 30% | 50% | 50% | 0% |
| Inpatient Hospital | 30% | 50% | 30% | 50% | 50% | 0% |
| Outpatient Surgery (ASC/Hospital) | 20%/30% | 40%/50% | 20%/30% | 40%/50% | 40%/50% | 0%/0% |
| Emergency Room | 30% | 50% | 30% | 50% | 50% | 0% |
| Urgent Care | $80 | $90 | $80 | $50 | $90 | 0% |
| Pharmacy7 | $25/$50/ 50%/50% | $25/$50/ 50%/50% | $25/$50/ 50%/50% | $350 deductible $155/$50 50%/50% | $25/$50 50%/50% | Integrated medical deductible 0%6/ 0%6/ 0%6/ 0%6 |
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.
| 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%/20%/ 20%/50% | 30%/30%/ 30%/50% | 30%/30%/ 30%/50% | 0%/0%/ 0%/0% |
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.
| Plan Name | Gold Standard Plan | Silver Standard Plan | Bronze 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% (SP: $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.
| 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% |
Participation Guidelines
Access to Health Net's Enhanced Choice portfolio requires the following guidelines:
1-5 Eligible Employees
+
66% Minimum Employee Participation
+
Employer Pays Minimum of 50% of Base Plan
=
Access to Health Net's Enhanced Choice Portfolio
6-50 Eligible Employees
+
50% Minimum Employee Participation
+
Employer Pays Minimum of 50% of Base Plan
=
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 on the Oregon State 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 at healthnetoregon.com 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 Only chiropractic and acupuncture benefits available on Oregon State Standard Plans.
11 In-and-out-of-network visits combined.
12 Not available for purchase alongside the Oregon State Standard Plans.
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.