PacificSource Elect FlexPerks

Oregon Health Insurance-Independent Health Insurance Agents

Portland (503)231-6399 Toll Free (888)426-9544

PacificSource was formed in 1933 as an organization of member physicians. Now that we serve all of Oregon, we put our decades of experience to work providing our customers with affordable coverage and the best possible service.

HSA qualified high deductible health plans.

PacificSource On Line Application

PacificSource Application.pdf

Preferred Provider List of Doctors and facilities

Maximum Lifetime Benefit	$2,000,000
Annual Deductible per person/family	Out of pocket limit including deductible per person
$1,100 / $2,200	$3,300 / $6,600
$1,500 / $3,000	$5,000 / $10,000
$2,000 / $4,000	$5,000 / $10,000
$2,900 / $5,800	$5,600 / $11,200
$5,000 / $10,000	$5,000 / $10,000

Accident Benefit	First $500 of covered expenses for care within 90 days of an accident covered at 100% (Deductible waived for treatment within the first 90 days)
Preventive Care	Participating Providers	Non-Participating Providers
Well Baby Care	80%	50%
Routine Physicals	80%	50%
Routine Gynecological Exams	80%	50%
Immunizations	80%	50%
Professional Services
Office and Home Visits	80%	50%
Urgent Care Center Visits	80%	50%
Surgery	80%	50%
Chiropractic Manipulation	Not covered	Not covered
Acupuncture & Naturopathic Care	Not covered	Not covered

Maternity Care
Practitioner Services	80%	50%
Hospital Stay	80%	50%
Hospital Services
Inpatient Room and Board	80%	50%
Inpatient Rehabilitative Care	80%	50%
Skilled Nursing Facility Care	80%	50%
Outpatient Services
Outpatient Hospital/Facility	80%	50%
Diagnostic & Therapeutic Radiology and Lab	80%	50%
CT Scans and MRIs	80%	50%
Emergency Room Visits	80%	50%
Other Covered Services
Prescription Drugs	50%	Not Covered
Physical Therapy	80%	50%
Allergy Injections	80%	50%
Ambulance Service	80%	50%
Durable Medical Equipment/Prosthesis	80%	50%
Home Health, Hospice, and Respite Care	80%	50%
Inpatient Mental Health Services	80%	50%
Transplant Services	80%	50% or $100,000 whatever is less

Monthly Premium Rates January 1, 2008.

Monthly premium for Elect FlexPerks HSA is step-rated based on the age of the oldest family member on the policy. Premium rates for this plan effective January 1, 2008 are as follows.

	Individual	Individual	Family	Individual

		&Spouse		&Child(ren)
Age	Deductible $1,100/$2,200
0-17	88
18-24	112	224	325	202
25-29	133	266	399	240
30-34	150	300	450	270
35-39	172	345	517	310
40-44	217	435	609	391
45-49	244	489	684	440
50-54	328	656	820	590
55-59	402	804	925	724
60-64	466	932	1026	839
65+	466	932	1026	839
	Individual	Individual	Family	Individual

		&Spouse		&Child(ren)
Age	Deductible $1,500/$3000
0-17	76
18-24	97	194	281	175
25-29	115	230	345	207
30-34	130	260	390	234
35-39	149	298	447	268
40-44	188	376	526	338
45-49	211	423	592	380
50-54	284	567	709	511
55-59	348	696	800	626
60-64	403	807	887	726
65+	403	807	887	726
	Individual	Individual	Family	Individual

		&Spouse		&Child(ren)
Age	Deductible $2,000/$4,000
0-17	67
18-24	86	172	250	155
25-29	102	204	306	184
30-34	115	230	346	207
35-39	132	265	397	238
40-44	167	334	467	300
45-49	188	375	525	338
50-54	252	503	629	453
55-59	309	617	710	555
60-64	358	716	787	644
65+	358	716	787	644
	Individual	Individual	Family	Individual

		&Spouse		&Child(ren)
Age	Deductible $2,900/$5,800
0-17	61
18-24	78	155	225	140
25-29	92	184	276	166
30-34	104	208	312	187
35-39	119	239	358	215
40-44	150	301	421	271
45-49	169	338	474	304
50-54	227	454	568	409
55-59	278	557	640	501
60-64	323	645	710	581
65+	323	645	710	581
	Individual	Individual	Family	Individual

		&Spouse		&Child(ren)
Age	Deductible $5,000/$10,000
0-17	60
18-24	77	155	225	139
25-29	92	184	276	165
30-34	104	207	311	187
35-39	119	238	357	214
40-44	150	300	420	270
45-49	169	337	472	304
50-54	226	453	566	408
55-59