All Employees
Benefit Claims/Coverage Questions? Contact the benefits team
Affidavit of Domestic Partnership
- Form (25KB pdf)
- Information Packet (30KB pdf)
- Memo (22KB pdf)
- Termination Form (19KB pdf)
COBRA
- Continuation Summary (199KB pdf)
Health Insurance Portability and Accountability Act (HIPAA)
- Initial Notice (11KB pdf)
- Notice of Privacy Practices (95KB pdf)
AFSCME, Nonbargaining, and Police
PacificSource
- Navigator 2000 Medical Benefit Summary (765KB pdf)
- Navigator 2000 Summary of Benefits and Coverage (71KB pdf)
- Medical Benefit Handbook (coming July 2023) (3.95MB pdf)
- MemberExtras (1.12MB pdf)
- Navigator Member Guide (511KB pdf)
- Navigator Network Map (259KB pdf)
- Pediatric Vision S2 Summary (792KB pdf)
- Prescription Drug Benefit 20-40-60 Summary (760KB pdf)
- Prescription Drug Benefit 20-80-50P Summary (761KB pdf)
If you are between 0.5-0.74 FTE and benefits eligible:
- Navigator 5000 Medical Benefit Summary (764KB pdf)
- Navigator 5000 Summary of Benefits and Coverage (73KB pdf)
- Medical Benefit Handbook (coming July 2023) (3.95MB pdf)
- MemberExtras (1.12MB pdf)
- Navigator Member Guide (511KB pdf)
- Navigator Network Map (259KB pdf)
- Pediatric Vision S2 Summary (792KB pdf)
- Prescription Drug Benefit 20-40-60 Summary (760KB pdf)
- Prescription Drug Benefit 20-80-50P Summary (761KB pdf)
moda / ODS Health Plans
Dental
- Delta Dental Handbook (coming July 2023) (2.27MB pdf)
- Delta Dental Summary (1.56MB pdf)
- Willamette Dental Handbook (1.9MB pdf)
- Willamette Dental Summary (130KB pdf)
Vision
- Moda Vision Handbook (1.74MB pdf)
- Moda Vision Summary (842KB pdf)
VEBA
Fire
Only fire department employees receive the medical benefits listed below:
Regence Blue Cross Blue Shield of Oregon
- 2022 BCBS Medical and Vision Benefit Summary (654KB pdf)
- 2023 BCBS Dental Benefit Summary (1.15MB pdf)
- 2023 BCBS Dental Summary of Benefits and Coverage (1.03MB pdf)
- 2023 BCBS Medical Summary of Benefits and Coverage (1.12MB pdf)
- 2023 BCBS Vision Summary of Benefits and Coverage (525KB pdf)
- ActiveFit Direct Gym Membership (170KB pdf)
- BlueCard PPO National Network (374KB pdf)
- Doctor on Demand Virtual Office Visits (556KB pdf)
- Global Core International Coverage (240KB pdf)
- myStrength Emotional Health Tool (945KB pdf)
- Regence Advantages Member Discounts (202KB pdf)
- Regence Advice24 Nurseline (483KB pdf)
- Regence App (113KB pdf)
- Regence Care Management (1.89MB pdf)
- Regence Empower Wellbeing Program (1.14MB pdf)
- Regence Preventive Flyer (298KB pdf)
