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
- 2024 PacificSource Member Handbook (1.67MB pdf)
- Navigator 2000 Medical Benefit Summary (188KB pdf)
- Navigator 2000 Summary of Benefits and Coverage (80KB pdf)
- MemberExtras (461KB pdf)
- Navigator Member Guide (1.77MB pdf)
- Navigator Network Map (259KB pdf)
- Pediatric Vision S2 Summary (176KB pdf)
- Prescription Drug Benefit 20-40-60 Summary (183KB pdf)
- Prescription Drug Benefit 20-80-50P Summary (181KB pdf)
If you are between 0.5-0.74 FTE and benefits eligible:
- 2024 PacificSource Member Handbook (1.67MB pdf)
- Navigator 5000 Medical Benefit Summary (189KB pdf)
- Navigator 5000 Summary of Benefits and Coverage (81KB pdf)
- MemberExtras (461KB pdf)
- Navigator Member Guide (1.77MB pdf)
- Navigator Network Map (259KB pdf)
- Pediatric Vision S2 Summary (176KB pdf)
- Prescription Drug Benefit 20-40-60 Summary (183KB pdf)
- Prescription Drug Benefit 20-80-50P Summary (181KB pdf)
moda / ODS Health Plans
Dental
Vision
VEBA
Fire
Only fire department employees receive the medical benefits listed below:
Regence Blue Cross Blue Shield of Oregon
- Enrollment and Change Form (1.19MB pdf)
- 2024 BCBS Dental Summary of Benefits and Coverage (1.06MB pdf)
- 2024 BCBS Medical Summary of Benefits and Coverage (1.22MB pdf)
- 2024 BCBS Vision Summary of Benefits and Coverage (750KB pdf)
- ActiveFit Direct Gym Membership (1.51MB pdf)
- BlueCard PPO National Network (374KB pdf)
- Doctor on Demand Virtual Office Visits (556KB pdf)
- Regence Advantages Member Discounts (202KB pdf)
- Regence Advice24 Nurseline (483KB pdf)
- Regence App (113KB pdf)
- Regence Care Management (1.43MB pdf)
- Regence Empower Wellbeing Program (1.09MB pdf)
- Regence Preventive Flyer (298KB pdf)
- Member Open Enrollment Booklet (4.14MB pdf)
