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Group plan documents

Below are group plan documents for our medical plans.

2022 small group benefit summaries

Plan Tier Plan Type 2022 Oregon Small Group plans (1-50) In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance SB SBC
Platinum
1-Platinum Connexus Platinum No deductible $0 $8,550 15%
1-Platinum Connexus Platinum 250 $250 $3,250 $15/visit
1-Platinum Connexus Platinum 500 $500 $3,250 $15/visit
1-Platinum Moda Select Platinum 500 $500 $3,850 $20/visit
Gold
2-Gold Connexus Gold No Deductible $0 $8,550 30%
2-Gold Connexus Gold 500 $500 $6,750 $30/visit
2-Gold Moda Select Gold 500 $500 $8,700 $30/visit
2-Gold Connexus Gold 1000 $1,000 $6,750 $30/visit
2-Gold Moda Select Gold 1000 $1,000 $8,700 $40/visit
2-Gold Connexus Gold 1500 $1,500 $6,750 $30/visit
2-Gold Moda Select Gold 1500 $1,500 $8,700 $30/visit
2-Gold Connexus Gold 2000 $2,000 $8,550 $30/visit
2-Gold Connexus Gold HDHP 3000 $3,000 $3,000 0% after deductible
2-Gold Moda Health Connexus Oregon Standard Gold $1,500 $7,300 $20/visit
Silver
3-Silver Connexus Silver 2500 $2,500 $8,550 $40/visit
3-Silver Moda Select Silver 2500 $2,500 $8,700 $60/visit
3-Silver Connexus Silver 3000 $3,000 $8,550 $40/visit
3-Silver Moda Select Silver 3500 $3,500 $8,700 $40/visit
3-Silver Connexus Silver 4000 $4,000 $8,550 $40/visit
3-Silver Moda Select Silver 4500 $4,500 $8,700 $40/visit
3-Silver Connexus Silver 5000 $5,000 $8,550 $40/visit
3-Silver Moda Select Silver 5500 $5,500 $8,150 $40/visit
3-Silver Moda Select Silver HDHP 2000 $2,000 $6,750 30% after deductible
3-Silver Connexus Silver HDHP 3000 $3,000 $6,000 30% after deductible
3-Silver Moda Health Connexus Oregon Standard Silver $3,650 $8,550 $40/visit
Bronze
4-Bronze Connexus Bronze 5500 $5,500 $8,550 $60/visit
4-Bronze Moda Select Bronze 7500 $7,500 $8,550 $60/visit
4-Bronze Connexus Bronze 8550 $8,550 $8,550 0% after deductible
4-Bronze Moda Select Bronze HDHP 5500 $5,500 $7,000 50% after deductible
4-Bronze Connexus Bronze HDHP 6000 $6,000 $6,900 50% after deductible
4-Bronze Moda Health Connexus Oregon Standard Bronze $8,700 $8,700 $50/visit
Plan Tier Plan Type 2022 Alaska Small Group plans (1-50) In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance SB SBC
Gold Plans
1-Gold Select Endeavor Select Gold No Deductible $0 $8,550 30%
1-Gold Select Endeavor Select Gold 500 $500 $6,800 $30/visit
1-Gold Select Endeavor Select Gold 1000 $1,000 $6,400 $25/visit
1-Gold Select Endeavor Select Gold 1500 $1,500 $6,000 $25/visit
1-Gold Select Endeavor Select Gold 2000 $2,000 $6,000 $30/visit
1-Gold Select Endeavor Select Gold HDHP 1500 $1,500 $3,500 20% after deductible
1-Gold Select Pioneer Gold 500 (Tier 1) $500 $6,400 $25/visit
1-Gold Select Pioneer Gold 1000 (Tier 1) $1,000 $6,400 $25/visit
1-Gold Select Pioneer Gold 1500 (Tier 1) $1,500 $6,000 $25/visit
1-Gold Select Pioneer Gold 2000 (Tier 1) $2,000 $6,000 $25/visit
1-Gold Select Pioneer Gold 1500 HDHP (Tier 1) $1,500 $3,500 20% after deductible
Silver Plans
2-Silver Select Endeavor Select Silver 2500 $2,500 $8,550 $35/visit
2-Silver Select Endeavor Select Silver 3000 $3,000 $8,550 $35/visit
2-Silver Select Endeavor Select Silver 4000 $4,000 $8,550 $35/visit
2-Silver Select Endeavor Select Silver HDHP 2500 $2,500 $6,000 25% after deductible
2-Silver Select Endeavor Select Silver HDHP 3250 $3,250 $7,000 25% after deductible
2-Silver Select Pioneer Silver 2000 (Tier 1) $2,000 $8,550 $35/visit
2-Silver Select Pioneer Silver 2500 (Tier 1) $2,500 $8,550 $35/visit
2-Silver Select Pioneer Silver 3000 (Tier 1) $3,000 $8,550 $35/visit
2-Silver Select Pioneer Silver 4000 (Tier 1) $4,000 $8,550 $35/visit
2-Silver Select Pioneer Silver 2800 HDHP (Tier 1) $2,800 $5,400 25% after deductible
2-Silver Select Pioneer Silver 3500 HDHP (Tier 1) $3,500 $5,000 20% after deductible
Bronze Plans
3-Bronze Select Endeavor Select Bronze 6000 $6,000 $8,700 $80/visit
3-Bronze Select Endeavor Select Bronze 8550 $8,550 $8,550 0% after deductible
3-Bronze Select Endeavor Select Bronze HDHP 5950 $5,950 $7,000 40% after deductible
3-Bronze Select Endeavor Select Bronze HDHP 7000 $7,000 $7,000 0% after deductible
3-Bronze Select Pioneer Bronze 5500 (Tier 1) $5,500 $8,700 $80/visit
3-Bronze Select Pioneer Bronze 6350 (Tier 1) $6,350 $8,700 $55/visit
3-Bronze Select Pioneer Bronze 8550 (Tier 1) $8,550 $8,550 0% after deductible
3-Bronze Select Pioneer Bronze 5950 HDHP (Tier 1) $5,950 $7,000 40% after deductible
3-Bronze Select Pioneer Bronze 6900 HDHP (Tier 1) $6,900 $6,900 0% after deductible

2021 small group benefit summaries

Plan Tier Plan Type 2021 Oregon small group plans (1-50) In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance SB SBC
Platinum
1-Platinum Connexus Platinum No deductible $0 $8,550 15%
1-Platinum Connexus Platinum 250 $250 $3,250 $15/visit
1-Platinum Synergy Platinum 250 $250 $3,250 $15/visit
1-Platinum Connexus Platinum 500 $500 $3,250 $15/visit
1-Platinum Synergy Platinum 500 $500 $3,250 $15/visit
Gold
2-Gold Connexus Gold No Deductible $0 $8,550 30%
2-Gold Connexus Gold 500 $500 $6,750 $30/visit
2-Gold Synergy Gold 500 $500 $6,750 $30/visit
2-Gold Connexus Gold 1000 $1,000 $6,750 $30/visit
2-Gold Synergy Gold 1000 $1,000 $6,750 $30/visit
2-Gold Connexus Gold 1500 $1,500 $6,750 $30/visit
2-Gold Synergy Gold 1500 $1,500 $6,750 $30/visit
2-Gold Connexus Gold 2000 $2,000 $8,550 $30/visit
2-Gold Synergy Gold 2000 $2,000 $8,550 $30/visit
2-Gold Connexus Gold HDHP 3000 $3,000 $3,000 0% after deductible
2-Gold Moda Health Oregon Standard Gold $1,500 $7,300 $20/visit
Silver
3-Silver Connexus Silver 2500 $2,500 8550 $40/visit
3-Silver Synergy Silver 2500 $2,500 $8,550 $40/visit
3-Silver Connexus Silver 3000 $3,000 $8,550 $40/visit
3-Silver Synergy Silver 3000 $3,000 $8,550 $40/visit
3-Silver Connexus Silver 4000 $4,000 $8,550 $40/visit
3-Silver Synergy Silver 4000 4000 $8,550 $40/visit
3-Silver Connexus Silver 5000 5000 $8,550 $40/visit
3-Silver Synergy Silver 5000 5000 $8,550 $40/visit
3-Silver Connexus Silver HDHP 3000 3000 6000 30% after deductible
3-Silver Moda Health Oregon Standard Silver 3650 $8,550 $40/visit
Bronze
4-Bronze Connexus Bronze 5500 5500 $8,550 $60/visit
4-Bronze Connexus Bronze 8550 $8,550 $8,550 0% after deductible
4-Bronze Connexus Bronze HDHP 6000 6000 6900 50% after deductible
4-Bronze Moda Health Oregon Standard Bronze $8,550 $8,550 $50/visit
Plan Tier Plan Type 2021 Alaska small group plans (1-50) In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance SB SBC
Gold Plans
1-Gold Select Endeavor Select Gold No Deductible $0 $8,550 30%
1-Gold Select Endeavor Select Gold 500 $500 $6,750 $30/visit
1-Gold Select Endeavor Select Gold 1000 $1,000 $6,750 $30/visit
1-Gold Select Endeavor Select Gold 1500 $1,500 $6,750 $30/visit
1-Gold Select Endeavor Select Gold 2000 $2,000 $6,750 $30/visit
1-Gold Select Endeavor Select Gold HDHP 1500 $1,500 $3,500 20% after deductible
1-Gold Select Pioneer Gold 750 (Tier 1) $750 $5,000 $25/visit
1-Gold Select Pioneer Gold 1500 (Tier 1) $1,500 $5,000 $25/visit
1-Gold Select Pioneer Gold 1500 HDHP (Tier 1) $1,500 $3,500 20% after deductible
Silver Plans
2-Silver Select Endeavor Select Silver 2500 $2,500 $8,550 $40/visit
2-Silver Select Endeavor Select Silver 3000 $3,000 $8,550 $40/visit
2-Silver Select Endeavor Select Silver 4000 $4,000 $8,550 $40/visit
2-Silver Select Endeavor Select Silver HDHP 2500 $2,500 $6,000 25% after deductible
2-Silver Select Endeavor Select Silver HDHP 3250 $3,250 $7,000 25% after deductible
2-Silver Select Endeavor Select Silver HDHP 4000 $4,000 $7,000 25% after deductible
2-Silver Select Endeavor Select Silver HDHP 5000 $5,000 $6,400 25% after deductible
2-Silver Select Pioneer Silver 2500 (Tier 1) $2,500 $6,000 25% after deductible
2-Silver Select Pioneer Silver 4000 (Tier 1) $4,000 $7,000 25% after deductible
2-Silver Select Pioneer Silver 2500 HDHP (Tier 1) $2,500 $8,550 $35/visit
2-Silver Select Pioneer Silver 4000 HDHP (Tier 1) $4,000 $8,550 $35/visit
Bronze Plans
3-Bronze Select Endeavor Select Bronze 4000 $4,000 $8,550 50% after deductible
3-Bronze Select Endeavor Select Bronze 5000 $5,000 $8,550 50% after deductible
3-Bronze Select Endeavor Select Bronze 6000 $6,000 $8,550 $55/visit
3-Bronze Select Endeavor Select Bronze 8550 $8,550 $8,550 $55/visit
3-Bronze Select Endeavor Select Bronze HDHP 7000 $7,000 $7,000 0% after deductible
3-Bronze Select Pioneer Bronze 5000 (Tier 1) $5,000 $8,550 $50/visit
3-Bronze Select Pioneer Bronze 6500 (Tier 1) $6,500 $8,550 $50/visit
3-Bronze Select Pioneer Bronze 8550 (Tier 1) $8,550 $8,550 $50/visit
3-Bronze Select Pioneer Bronze 7000 HDHP (Tier 1) $7,000 $7,000 0% after deductible

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