Benefit Claims/Coverage Questions? Contact the Benefits Team
AFSCME, Nonbargaining, and Police employees
PacificSource Medical Plan Summary Information
- Alternative Care Summary (140KB pdf)
- PSN Medical Summary (602KB pdf)
- PacificSource Medical Benefit Handbook (2.16MB pdf)
- Pharmacy Summary (563KB pdf)
PacificSource Medical Information and Forms
- 24–Hour NurseLine (407KB pdf)
- Enrollment and Change Form (124KB pdf)
- Hospital Based Health Education Classes (462KB pdf)
- InTouch Access Information (441KB pdf)
- PacificSource Member Guide (1.09MB pdf)
- Teledoc Information (550KB pdf)
- Web Site
- Weight Watchers Program (600KB pdf)
PacificSource - Mail Service Pharmacy
- Pharmacy Mail Service-CVS Caremark-Information (150KB pdf)
- Pharmacy Mail Service-CVS Caremark-Order Form (170KB pdf)
moda / ODS Health Plans
- Enrollment and Change Form (124KB pdf)
- Vision Reimbursement Claim Form (178KB pdf)
- Web Site
- moda Delta Dental Handbook (1.83MB pdf)
- moda Delta Dental Summary (181KB pdf)
- moda Vision Handbook (1.49MB pdf)
- moda Vision Summary (152KB pdf)
- moda Willamette Dental Handbook (1.6MB pdf)
- moda Willamette Dental Summary (116KB pdf)
VEBA
Travel Insurance
A comprehensive program of information, referral, assistance, transportation and evacuation services designed to help you respond to medical care situations and many other emergencies that may arise during travel. (Provided by MEDEX Assistance Corporation.)
- Medex Employee Brochure (743KB pdf)
Fire Employees Only
Albany Fire Department employees only receive medical benefits listed below
Regence Blue Cross Blue Shield of Oregon
- BCBS Enrollment and Change Form (1.19MB pdf)
- BCBS Medical summary of benefits (ACA) (690KB pdf)
- BCBS Booklet (Dental) (1.13MB pdf)
- BCBS Booklet (Medical and Vision) (1.17MB pdf)
- Complimentary Care Benefit Summary (24KB pdf)
- Request a new ID Card
- Web Site
All Employees 
COBRA
- Continuation Summary (199KB pdf)
Health Insurance Portability and Accountability Act (HIPAA)
- Initial Notice (11KB pdf)
- Notice of Privacy Practices (95KB pdf)