PacificSource Medical Plan Summary Information

• Alternative Care Summary (140KB pdf)
• Medical Summary of Benefits and Coverage (ACA) (308KB pdf)
• PSN Medical Summary (761KB pdf)
• PacificSource Medical Benefit Handbook (2.67MB pdf)
• Pharmacy Summary (196KB pdf)

PacificSource Medical Information and Forms

• Enrollment and Change Form (124KB 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 (2.82MB pdf)
• moda Delta Dental Summary (1.4MB pdf)
• moda Vision Handbook (1.26MB pdf)
• moda Vision Summary (372KB pdf)
• moda Willamette Dental Benefit Summary (193KB pdf)
• moda Willamette Dental Handbook (2.63MB pdf)

VEBA

• Care Card Questions (272KB pdf)
• Definition of a-Dependent (196KB pdf)
• Letter of Medical Necessity (422KB pdf)
• VEBA Claim Form (557KB pdf)
• Web Site
  

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)