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Bend Chamber of Commerce2020 Health Plans
About PacificSourceMore than Just InsuranceAt PacificSource, our commitment to serving you goes beyond paying claims andproviding outstanding customer service. As a community health plan, our role is to helpyour enrolled employees use their benefits to their healthiest advantage, managing costswhile providing the best possible care experience.Benefits that Fit Your NeedsAbout Bend ChamberThe Bend Chamber is a vital strategic partner creating resources and opportunitiesfor member success, quality of life, engagement, and meaningful impact. We provideprograms and resources to enhance achievement of our members’ organizational goals.One such initiative is group health coverage: With Teladoc , members have on-demand access to doctors by phone, onlinevideo, or mobile app. A 0 copay takes care of a broad list of preventive generic drugs. Acupuncture/chiropractic manipulation coverage is available to all groups. Vision coverage is available to all groups. If a group takes the vision coverage, it willsatisfy the pediatric vision requirement. Dental plans are available to all medical groups and on a stand-alone basis for groupsof five or more. Note: the dental plans do not include pediatric dental benefits. Affordable rates and benefits to qualifying Chamber members Orthodontic coverage is available to groups of 10 or more enrolled employees. Opportunity for substantial savings Domestic partner benefits are available to all groups. Focus on prevention and wellness A 25,000 Additional Death & Dismemberment employee-only benefit is includedfor those enrolled in the medical plan. (This benefit is offered through USAble Life.) 12-month rate guarantee from enrollment dateTo participate in one of the Chamber plans, you must maintain membership in goodstanding and have an associate agreement with the Bend Chamber.5% Medical Premium Discount for Wellness Program Participation COBRA administration through PacificSource Administrators is available at noextra cost.Travel NetworksIf you’re new to the Bend Chamber health plan and have a group of 10 or more enrolledemployees, you may be eligible for a five percent wellness discount. This discount is onlyavailable for your first year with Bend Chamber. Please see your agent for details.If your employees experience an emergency or need urgent care when traveling outsideof Idaho, Montana, Oregon, or Washington, they have access to providers nationwide.We partner with First Choice Health Network in Alaska and with First Health Network for all other states.Give Your Employees a Choice of PlansAssist America As an employer with the Bend Chamber, you may be able to offer more than one plan.Employees appreciate having choices, especially when it comes to their healthcare. Youcan give your employees the opportunity to choose a plan that best suits their needs. Talkwith your Johnson Benefit Planning or PacificSource sales representative to learn aboutyour options.If your employees experience a medical emergency while 100 or more miles fromhome or traveling abroad, they can access services provided by Assist America GlobalEmergency Services at no cost. Once your employee is under the care of a physician ormedical facility, their PacificSource coverage applies.Note: If an employee lives outside the SmartChoice, Navigator, or Pathfinder Networkplan service area, they will need to choose a Voyager Network plan (formerly namedPacificSource Network or PSN). This will ensure they have access to in-network providers.23
HSA Plans May be paired with a health savings account (HSA)Medical Plan BenefitsAll plans: Coverage of Essential Health Benefits, including coverage for mental health andchemical dependency No-cost preventive care Calendar-year benefits All member out-of-pocket costs for covered services apply toward the annualout-of-pocket limit Naturopathic office visits covered at the primarcy care copayment level Referrals not required for specialty careIn addition, Premier Plans feature: Deductible waived for outpatient physical therapy visitsMedical PlansVoyager Plans For employees living in any location Access to participating providers in Oregon, Idaho, Montana, and southern countiesin Washington, as well as access to a nationwide travel network of providersNavigator Plans For employees living in Clackamas, Multnomah, Washington, Yamhill, Crook,Deschutes, and Jefferson counties Coordinated-care experience at select provider partner groups and facilities Deductible waived on lab/X-ray Urgent care covered for the same copay as an office visit with a specialist Combined deductible for in- and out-of-network servicesPrimary Care Providers for SmartChoice PlansPrimary care providers (PCPs) may include practitioner designations such as: Doctor of Osteopathic Medicine (DO) Medical Doctor (MD) Nurse Practitioner (NP) Physician Assistant (PA)PCPs may be providers who specialize in: Family PracticeSmartChoice Network (SCN) Plans For employees living in Benton, Lane, Linn, Marion, Polk, Coos, Curry, Douglas,Jackson, and Josephine counties Partner with a primary care provider (PCP)Pathfinder Plans For employees living in Clackamas, Multnomah, and Washington counties Powered by Legacy Health, OHSU, Adventist Health and Tuality Healthcare4 General Practice Geriatrics Internal Medicine Obstetrics-Gynecology PediatricsTo check if a specific provider has a PCP designation for your health plan, visit ourProvider Directory at PacificSource.com/find-a-provider.Note: Employees who have a Voyager, Navigator, or Pathfinder plan, are not requiredto choose a PCP.5
2020 Bend Chamber Association Plan OptionsPremier Plans1000 25-50 20 S2CHOOSE A NETWORK Voyager Navigator SmartChoice Pathfinder1500 25-50 30 S22000 25-50 30 S23000 35-60 30 S25000 35-60 30 S2Voyager Navigator SmartChoice PathfinderVoyager Navigator SmartChoice PathfinderVoyager Navigator SmartChoice PathfinderVoyager Navigator SmartChoice PathfinderIN NETWORKOUT OF NETWORKIN NETWORKOUT OF NETWORKIN NETWORKOUT OF NETWORKIN NETWORKOUT OF NETWORKIN NETWORKOUT OF NETWORKDEDUCTIBLEIndividual / Family 1,000 / 2,000 1,000 / 2,000 1,500 / 3,000 1,500 / 3,000 2,000 / 4,000 2,000 / 4,000 3,000 / 6,000 3,000 / 6,000 5,000 / 10,000 5,000 / 10,000OUT-OF-POCKET MAXIMUMIndividual / Family 4,000 / 8,000 4,000 / 8,000 5,000 / 10,000 5,000 / 10,000 6,850 / 13,700 6,850 / 13,700 7,500 / 15,000 7,500 / 15,000 7,500 / 15,000 7,500 / 15,000NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:Covered in Full50%Covered in Full50%Covered in Full50%Covered in Full50%Covered in Full50%OFFICE VISITSPrimary 2550% 2550% 2550% 3550% 3550%OFFICE VISITSSpecialty and Urgent Care 5050% 5050% 5050% 6050% 6050%TELEMEDICINE 1050% 1050% 1050% 1050% 1050%PHYSICAL, OCCUPATIONAL,AND SPEECH THERAPY20%50%30%50%30%50%30%50%30%50%LAB / X-RAY20%50%30%50%30%50%30%50%30%50%PREVENTIVE SERVICES0% of first 1,000 within 90 days of the accident. Not subject to deductible.ACCIDENT BENEFIT 250, then 20%EMERGENCY SERVICES 250, then 30%AFTER DEDUCTIBLE, MEMBER PAYS:INPATIENT ANDOUTPATIENT HOSPITALIncluding surgical proceduresand advanced imaging20%50%NO DEDUCTIBLE, MEMBER PAYS:AFTER DEDUCTIBLE, MEMBER PAYS:30%50%NO DEDUCTIBLE, MEMBER PAYS:AFTER DEDUCTIBLE, MEMBER PAYS:30%50%NO DEDUCTIBLE, MEMBER PAYS: OR 10-50p-50p S2AFTER DEDUCTIBLE, MEMBER PAYS:30%NO DEDUCTIBLE, MEMBER PAYS:30%50%NO DEDUCTIBLE, MEMBER PAYS: OR 10-50-75 S2Pick one :Preventive drugs: 0PRESCRIPTION (Rx)DRUG COVERAGE 50%AFTER DEDUCTIBLE, MEMBER PAYS:Preventive drugs: 030-day supplyTier 1: 10, Tier 2: 50%, Tier 3: 50%30-day supplyTier 1: 10, Tier 2: 50, Tier 3: 75OR90-day retail or mail order supplyAll Tiers: 3 x copay90-day retail or mail order supplyTier 1: 2 x copay (mail order) / 3 x copay (retail), Tier 2 and 3: 3 x copayOPTIONAL BENEFITSALTERNATIVE CARE*VISION6 25After Deductible50% 25After Deductible50% 25After Deductible50% 35After Deductible50% 35After Deductible50%Routine vision exam: 10 Vision hardware (age 19 and older): Covered in full up to 200 Vision hardware (through age 19): One pair per calendar year covered in full (frames and lenses)* Acupuncture and chiropractic manipulation. 1,000 maximum per person per calendar year. Voyager network uses the Preferred Drug List (PDL). Navigator, Pathfinder, and SmartChoice networks use the Oregon Drug List (ODL). Not all networks are available in all counties.7
2020 Bend Chamber Association Plan OptionsHSA PlansHSA 3000 50 RX S2CHOOSE A NETWORK Voyager Navigator SmartChoice PathfinderChamber Core PlanChamber Core PlanHSA 4000 S2HSA 6000 RX S22500 35-70 50 S25000 35-70 50 S2Voyager Navigator SmartChoice PathfinderVoyager Navigator SmartChoice PathfinderVoyager Navigator SmartChoice PathfinderVoyager Navigator SmartChoice PathfinderIN NETWORKOUT OF NETWORKIN NETWORKOUT OF NETWORKIN NETWORKOUT OF NETWORKIN NETWORKOUT OF NETWORKIN NETWORKOUT OF NETWORKDEDUCTIBLEIndividual / Family 3,000 / 6,000 7,500 / 15,000 4,000 / 8,000 10,000 / 20,000 6,000 / 12,000 10,000 / 20,000 2,500 / 5,000 10,000 / 20,000 5,000 / 10,000 10,000 / 20,000OUT-OF-POCKET MAXIMUMIndividual / Family 6,000 / 12,000 15,000 / 30,000 4,000 / 8,000 20,000 / 40,000 6,000 / 12,000 20,000 / 40,000 7,500 / 15,000 12,700 / 25,400 8,000 / 16,000 12,700 / 25,400NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:NO DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:Covered in Full50%Covered in Full50%Covered in Full50%Covered in Full50%Covered in Full50%OFFICE VISITSPrimaryAfter Deductible50%50%After Deductible,Covered in Full50%After Deductible,Covered in Full50% 3550% 3550%OFFICE VISITSSpecialty and Urgent CareAfter Deductible50%50%After Deductible,Covered in Full50%After Deductible,Covered in Full50% 7050% 7050%TELEMEDICINEAfter Deductible50%50%After Deductible,Covered in Full50%After Deductible,Covered in Full50% 1050% 1050%PHYSICAL, OCCUPATIONAL,AND SPEECH THERAPYAfter Deductible50%50%After Deductible,Covered in Full50%After Deductible,Covered in Full50%After Deductible50%50%After Deductible50%50%LAB / X-RAYAfter Deductible50%50%After Deductible,Covered in Full50%After Deductible,Covered in Full50%After Deductible50%50%After Deductible50%50%PREVENTIVE SERVICES0% of first 1,000 within 90 days of the accident. Not subject to deductible.ACCIDENT BENEFITAfter Deductible, 50%After Deductible, Covered in FullAfter Deductible, Covered in FullAfter Deductible, 50%After Deductible, 50%AFTER DEDUCTIBLE, MEMBER PAYS:AFTER DEDUCTIBLE, MEMBER PAYS:AFTER DEDUCTIBLE, MEMBER PAYS:AFTER DEDUCTIBLE, MEMBER PAYS:AFTER DEDUCTIBLE, MEMBER PAYS:EMERGENCY SERVICESINPATIENT ANDOUTPATIENT HOSPITALIncluding surgical proceduresand advanced imagingPRESCRIPTION (Rx)DRUG COVERAGE 50%50%Covered in Full50%Covered in Full50%50%50%50%50%AFTER DEDUCTIBLE, MEMBER PAYS:AFTER DEDUCTIBLE, MEMBER PAYS:AFTER DEDUCTIBLE, MEMBER PAYS:NO DEDUCTIBLE, MEMBER PAYS:NO DEDUCTIBLE, MEMBER PAYS:OR-0-50P S2OR 0-4000D S2OR 0-6000D S2OR 10-50P-50P S2 ODLOR 10-50P-50P S2 ODLPreventive drugs: 0Preventive drugs: 0Preventive drugs: 0Preventive drugs: 0Preventive drugs: 030-day supplyTier 1: 50%, Tier 2: 50%, Tier 3: 50%30-day supplyTier 1: 0%, Tier 2: 0%, Tier 3: 0%30-day supplyTier 1: 0%, Tier 2: 0%, Tier 3: 0%30-day supplyTier 1: 10, Tier 2: 50%, Tier 3: 50%30-day supplyTier 1: 10, Tier 2: 50%, Tier 3: 50%90-day retail or mail order supply50%90-day retail or mail order supply0%90-day retail or mail order supply0%90-day retail or mail order supplyAll Tiers: 3 x copay90-day retail or mail order supplyAll Tiers: 3 x copayOPTIONAL BENEFITSALTERNATIVE CARE*VISION8After Deductible50%After Deductible50%After Deductible,Covered in FullAfter Deductible50%After Deductible,Covered in FullAfter Deductible50% 35After Deductible50% 35After Deductible50%Routine vision exam: 10 Vision hardware (age 19 and older): Covered in full up to 200 Vision hardware (through age 19): One pair per calendar year covered in full (frames or lenses)* Acupuncture and chiropractic manipulation. 1,000 maximum per person per calendar year. Voyager network uses the Preferred Drug List (PDL). Navigator, Pathfinder, and SmartChoice networks use the Oregon Drug List (ODL). Not all networks are available in all counties.9
CLASS I SERVICES:Preventive Examinations(two exams per year) Bitewing films (four filmsevery six months) Dental cleaning orperiodontal maintenance(three services per year) Fluoride(four treatments per year) SealantsNote: Preventive care doesnot apply toward the annualmaximum benefit.Dental Advantage8% discount on dentalPair a PacificSource dental plan with your PacificSource medical planand receive an eight percent discount on the dental plan.Buy-up plan: You may select two dental plans to offer youremployees—a “base” plan and a “buy-up” plan. If an employee selectsthe buy-up dental plan, they would pay the difference in premium.Stand-alone dental plans are available for groups of five or moreenrolled employees.When a members use an Advantage Network dentist, theywill not be responsible for any excess charges and will payonly their plan’s coinsurance amount, up to the annual planmaximum. When member uses an out-of-network provider,a 50 deductible applies to all services.Restorative orComplicatedTreatment Complicated oral surgery Root canal therapy Periodontal surgeryNETWORKANNUAL DEDUCTIBLEANNUALMAXIMUM BENEFITDental Advantage20/50/75 50/1000Dental Advantage0/20/50 50/1000 or0/20/50 50/1500Dental AdvantageDental AdvantageNoneNone 1,000 1,000 or 1,500AFTER DEDUCTIBLE,MEMBER PAYS:AFTER DEDUCTIBLE,MEMBER PAYS:CLASS I SERVICES20%0%CLASS II SERVICES50%20%CLASS III SERVICES75%50%Class III: 6 monthsClass III: 6 months 1,000 max (optional) 1,000 max (optional)Per personCOINSURANCE:CLASS III SERVICES:Major Treatment Crowns Dentures Bridges ImplantsOnce your employees are all signed up andenjoying their coverage, you can manage yourorganization’s health plan using InTouch forEmployers. It’s like InTouch for Members, butthis one is for you, the group administrator.With InTouch for Employers, you can: Access member information, request IDcards, and print temporary ID cards Administer enrollment and run basic reports Add or update personal information View and pay bills Fillings Periodontal scalingManage your company’s plan withInTouch for Employers Download enrollment dataCLASS II SERVICES: Simple surgicalextractionsFree Tools and ProgramsWAIT PERIODPer personORTHODONTIA*Employees can access benefits 24/7with InTouch for MembersThrough InTouch, our secure website formembers, your employees can check out theirclaims, preauthorization status, progress towardtheir plan’s deductibles, and more. They can login or sign up for InTouch at PacificSource.com.See if a service requirespreauthorizationSee how a drug is coveredWe offer prescription drug lists to providers sothey have the information they need to keepdrug costs low for your employees. To help withthat, we substitute generic drugs in place ofname brand drugs whenever we can. In mostcases, we also offer preventive drugs at no cost.For more information, visit PacificSource.com/drug-list, and select the drug list for your plan.Check out these extras foryour healthYour employees can also enjoy these extrabenefits and wellness programs: Active&Fit Direct gym membershipprogram 24-Hour NurseLine Assist America Global Emergency Services Case management services Condition Support program Health Education Reimbursement program Prenatal program Quit For Life tobacco cessation Weight management programsSometimes, your employees will need a medicalservice, procedure, or prescription that needs tobe preauthorized—approved in advance—beforetheir health plan will pay.You’ll find details about these programs andservices at PacificSource.com/extras.Our preauthorization lists outline commoninstances when your employees will need to getpreauthorization. However, some plans may notcover all items on the lists.Your employees will also have free access to:Visit PacificSource.com/provider/preauthorization for more information.Wait, there’s more! myPacificSource mobile app(PacificSource.com/mobile) CaféWell health and wellness portal(PacificSource.com/cafewell)*Groups of 10 or more enrolled employees may purchase orthodontiacoverage with any of the above dental policies. This coverage pays50% of the charge for orthodontics up to a 1,000 per person lifetimemaximum. Additional eligibility requirements may apply.1011
Working together for youWe’ve teamed up with Legacy Health, and we’re taking what weeach do best to create something great! With our health insuranceexpertise and Legacy’s strong hospital and provider networks ofmore than 2,400 providers, you and your employees get the best ofboth worlds.And while Legacy primarily serves the Portland Metro area, we’retaking what we learn from this partnership to apply it across thecommunities we serve in Idaho, Montana, Oregon, and Washington.Together, we’re creating a future of healthcare where providers andinsurance carriers work together to give you and your employees thequality healthcare you deserve.Questions?You’re always welcome to contact your local agent or us.AgentJohnson Benefit Planning(541) 382-3571 or toll-free (800) 314-3571Fax: (541) 382-3807Email: lisa@johnsonbenefitplanning.comWebsite: JohnsonBenefitPlanning.com777 NW Wall St Ste 100, Bend OR 97703Bend Chamber of CommerceBend Chamber(541) 382-3221Fax: (541) 385-9929Email: shelley@bendchamber.orgWebsite: 777 NW Wall St Ste 200, Bend OR 97703Contact PacificSourceBend:(541) 330-8896 (888) omYour employees’ privacy is important to us. To learn more abouthow we protect our members’ personal information, check out ourprivacy policy at PacificSource.com/privacy.LRG34 110119
5% Medical Premium Discount for Wellness Program Participation If you're new to the Bend Chamber health plan and have a group of 10 or more enrolled employees, you may be eligible for a five percent wellness discount. This discount is only available for your first year with Bend Chamber. Please see your agent for details.
