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
$1,500 / $3,000	$5,000 / $10,000
$2,000 / $4,000	$5,000 / $10,000
$3,000 / $6,000	$5,800 / $11,600
$5,000 / $10,000	$5,000 / $10,000

Accident Benefit	First $1000 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	70%	50%
Routine Physicals	70%	50%
Routine Gynecological Exams	70%	50%
Immunizations	70%	50%
Professional Services
Office and Home Visits	70%	50%
Urgent Care Center Visits	70%	50%
Surgery	70%	50%
Chiropractic Manipulation	Not covered	Not covered
Acupuncture & Naturopathic Care	Not covered	Not covered

Maternity Care
Practitioner Services	70%	50%
Hospital Stay	70%	50%
Hospital Services
Inpatient Room and Board	70%	50%
Inpatient Rehabilitative Care	70%	50%
Skilled Nursing Facility Care	70%	50%
Outpatient Services
Outpatient Hospital/Facility	70%	50%
Diagnostic & Therapeutic Radiology and Lab	70%	50%
CT Scans and MRIs	70%	50%
Emergency Room Visits	70%	50%
Other Covered Services
Prescription Drugs	50%	Not Covered
Physical Therapy	70%	50%
Allergy Injections	70%	50%
Ambulance Service	70%	50%
Durable Medical Equipment/Prosthesis	70%	50%
Home Health, Hospice, and Respite Care	70%	50%
Inpatient Mental Health Services	70%	50%
Transplant Services	70%	50% or $100,000 whatever is less

The percentage of coverage is 100% on the $5000 deductible plan, after the deductible is paid for participating providers.

Monthly Premium Rates January 1, 2009.

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, 2009 are as follows.

Deductible $1,500/$3000
	Individual	Individual	Family	Individual

		&Spouse		&Child(ren)
Age
0-17	93
18-20	117	235	340	211
21-24	121	243	352	218
25-29	141	282	422	253
30-34	160	319	479	287
35-39	176	351	527	316
40-44	222	444	621	399
45-49	260	520	727	468
50-54	348	697	871	627
55-59	427	853	981	768
60-64	496	991	1090	892
65+	496	991	1090	892
Deductible $2,000/$4,000
	Individual	Individual	Family	Individual

		&Spouse		&Child(ren)
Age
0-17	83
18-20	105	210	304	189
21-24	108	217	314	195
25-29	126	251	377	226
30-34	143	285	428	257
35-39	157	314	470	282
40-44	198	396	555	357
45-49	232	464	650	418
50-54	311	622	778	560
55-59	381	762	876	686
60-64	443	885	974	797
65+	443	885	974	797
Deductible $3,000/$6,000
	Individual	Individual	Family	Individual

		&Spouse		&Child(ren)
Age
0-17	76
18-20	96	192	278	173
21-24	99	198	288	179
25-29	115	230	345	207
30-34	131	261	392	235
35-39	144	287	431	258
40-44	181	363	508	327
45-49	212	425	595	382
50-54	285	570	712	513
55-59	349	698	802	628
60-64	405	810	891	729
65+	405	810	891	729
Deductible $5,000/$10,000
	Individual	Individual	Family	Individual

		&Spouse		&Child(ren)
Age
0-17	71
18-20	90	180	261	165
21-24	93	186	270	168
25-29	108	216	324	194
30-34	122	245	367	220
35-39	135	269	404	242
40-44	170	340	477	306
45-49	199	399	558	359
50-54	267	535	668	481
55-59	327	655	753	589
60-64	380	760	836	684
65+	380	760	836	684

PacificSource Application.pdf

Preferred Provider List of Doctors and facilities

Privacy Statement- This request will be absolutely confidential. The information will not be sold, given away or used for any other purpose but to mail or email requested information.

Information Request Form

This is not an application for insurance. In the state of Oregon, Individual Health Insurance plans must be approved in the underwriting stage of the insurance application. This might take a few weeks to complete. Please leave your name address and questions and any information that you would like.

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PacificSource Application.pdf

Information Request Form

Send mail to frs@xprt.net with questions or comments about this web site. Copyright © 1999 INDEPENDENT HEALTH INSURANCE AGENTS

Send mail to frs@xprt.net with questions or comments about this web site.
Copyright © 1999 INDEPENDENT HEALTH INSURANCE AGENTS