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Small Group Resources
Coronavirus Updates to Share with Members
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Oregon standardized group profile form
2019 Underwriting guidelines
2019 Member enrollment, termination, change & waiver form
2019 Group application
2019 Policy application addendum
2019 to 2020 comparable plans crosswalk
2020 Summary of benefit changes
2020 Underwriting guidelines
2020 Member enrollment, termination, change & waiver form
2020 Member enrollment, termination, change & waiver form - Spanish
2020 Group application
2020 Policy application addendum
2020 Renewal change form
Tier 1 - 20% Coinsurance
Performance Platinum 500
Performance Gold 1000
Performance Gold 2000
Performance Gold 3150
Performance Gold 4000
Tier 2 - 30% Coinsurance
Performance Gold 500
Performance Gold 1000
Performance Gold 1500
Performance Gold 2500
Performance Silver 5000
Performance Silver 6850
Tier 3 - 50% Coinsurance
Performance Gold 500
Performance Gold 1000
Performance Silver 3100
Performance Silver 4000
Performance Silver 5000
Performance Silver 6850
High Deductible Health Plan
Performance Silver 2800 HDHP
Performance Silver 3500 HDHP
Performance Bronze 5000 HDHP
Performance Bronze 6850 HDHP
Standard
Oregon Standard Silver
Oregon Standard Bronze
Basic
Tier 1 - 20% Coinsurance
Performance Platinum 500Performance Gold 1000
Performance Gold 2000
Performance Gold 3150
Performance Gold 4000
Tier 2 - 30% Coinsurance
Performance Gold 500Performance Gold 1000
Performance Gold 1500
Performance Gold 2500
Performance Silver 5000
Performance Silver 6850
Tier 3 - 50% Coinsurance
Performance Gold 500Performance Gold 1000
Performance Silver 3100
Performance Silver 4000
Performance Silver 5000
Performance Silver 6850
High Deductible Health Plan
Performance Silver 2800 HDHPPerformance Silver 3500 HDHP
Performance Bronze 5000 HDHP
Performance Bronze 6850 HDHP
Standard
Oregon Standard SilverOregon Standard Bronze
Basic
Performance Bronze BasicBenefit Summaries
Tier 1 - 20% Coinsurance
Performance Platinum $500
Performance Platinum $750
Performance Gold $1,000
Performance Gold $2,000
Performance Gold $3,000
Performance Silver $5,250
Performance Silver $6,850
Performance Silver $7,150
Performance Silver $7,350
Tier 2 - 30% Coinsurance
Performance Gold $500
Performance Gold $750
Performance Gold $1,000
Performance Gold $1,500
Performance Gold $2,000
Performance Silver $3,250
Performance Silver $3,500
Performance Silver $4,000
Performance Silver $5,000
Performance Silver $6,850
Performance Silver $7,150
Performance Silver $7,350
Tier 3 - 50% Coinsurance
Performance Gold $500
Performance Gold $750
Performance Gold $1,000
Performance Silver $1,750
Performance Silver $2,000
Performance Silver $2,500
Performance Silver $3,000
Performance Silver $3,500
Performance Silver $4,000
Performance Silver $5,000
Performance Silver $6,850
Performance Silver $7,150
Performance Silver $7,350
Health Savings Account-Eligible
Performance Silver $2,700 HSA
Performance Silver $3,500 HSA
Performance Silver $4,000 HSA
Performance Bronze $6,750 HSA
Standard
Oregon Standard Silver
Oregon Standard Bronze
Basic
Additional Benefit Information
Benefit Information
2018 Small Group Certificate for Health & Wellbeing, Standard and New Performance Plans
2018 Health & Wellbeing 2500
2018 Health & Wellbeing 3000
2018 Health & Wellbeing 5000
2018 Samaritan Oregon Standard Bronze
2018 Samaritan Oregon Standard Silver
2018 New Performance
2018 Prior Authorization List
2018 Creditable Coverage Summary