Health Plans

PacificSource Health Plans of Oregon

2017 PacificSource Health Plans in Oregon

Preferred Provider Organization (PPO) plans

PacificSource Health Plan List

Plan Name Plan Type Summaries SBC Networks

Plan Rates

Legacy Network Plans - Available in Clackamas, Multnomah & Washington Counties
Standard Bronze PPO Benefit Summary Coverage Outline Provider Directory
Drug List
Standard Silver PPO Benefit Summary Coverage Outline Provider Directory
Drug List
Standard Gold PPO Benefit Summary Coverage Outline Provider Directory
Drug List
Catastrophic* PPO Benefit Summary Coverage Outline Provider Directory
Drug List
Smart Choice Network Plans - Available in Crook, Deschutes & Jefferson Counties
Standard Bronze PPO Benefit Summary Coverage Outline Provider Directory
Drug List
Standard Silver PPO Benefit Summary Coverage Outline Provider Directory
Drug List
Standard Gold PPO Benefit Summary Coverage Outline Provider Directory
Drug List
Catastrophic* PPO Benefit Summary Coverage Outline Provider Directory
Drug List

* Eligibility requirements apply for Catastrophic coverage. To qualify, you must be younger than 30 years old, or get a “hardship exemption” because the marketplace determined that you are unable to afford healthcare coverage.

10 Essential Benefits

Healthcare reform says all health plans must include ten essential benefits. The basic benefits include:

  1. Outpatient Care - the kind you get without being admitted to a hospital
  2. Emergency Services - for issues that could lead to death or disable you if you do not treat them.
  3. Inpatient Care - covers room and board, tests, drugs, and care from doctors and nurses while admitted, which may include organ and tissue transplants, and hospice and respite care.
  4. Maternity and Newborn Care - care before and after your baby is born
  5. Mental Health and Substance Use Disorder Services - this includes behavioral health treatment, counseling, and psychotherapy.
  6. Prescription Drugs - covers retail, mail order, and specialty drugs.
  7. Rehabilitative and Habilitative Services - services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8. Laboratory Services - covers lab tests, X-ray services, and pathology, and imaging and diagnostics such as MRI, CT scan, and PET scan.
  9. Preventive and Wellness Services - including mammograms, colonoscopies, vaccines. Covered in full if you use in-network providers for care such as routine physicals, screening, and immunizations. Disease management coordinates care for diabetes, asthma, and other conditions.
  10. Pediatric Services - including dental care (preventive, basic, major) and vision care (eye exam, lenses, and eyewear).