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Group plan documents

Below are group plan documents for our medical plans.

2024





2024 Small group benefit summaries

2024





2024 Small group benefit summaries

Endeavor Select medical plan options

Pioneer medical plan options

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

2021 Small group benefit summaries

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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