Health Plan Coverage Notice
As the sponsor of group health plans, Clackamas County is required under various laws and regulations to provide certain notices about your rights related to health plan coverage. You do not need to do anything with regard to these notices. They are for your information only. If you have any questions regarding these notices, you may contact:
Clackamas County Human Resources
Attn: Benefits and Wellness Division
2051 Kaen Rd, Ste 310
Oregon City, OR 97045
503-655-8550
benefits@clackamas.us
Plan participants are responsible for providing a copy of this Notice to their Medicare eligible dependents covered under the plan.
Clackamas County is committed to offering a high-quality benefits package to support employees and their families.
Below is a list of benefits available to regular status Clackamas County employees. Benefit eligibility for regular status employees is based on your employee group. You must enroll in any plan for which you also wish to enroll a dependent. Individual plans may have additional eligibility criteria. Benefit information is subject to change.
General County
Choose from three medical plans.
| Kaiser | Providence Personal Option | Providence Open Option | ||
|---|---|---|---|---|
| medical services | in-network coverage only | in-network coverage only | in-network | out of network |
| annual deductible - single/family | $250/$500 | $850/$1,700 | $600/$1,200 | |
| annual out of pocket max - single/family | $1,000/$2,000 | $2,500/$5,000 | $2,000/$4,000 | |
office visit - primary and specialty urgent care | $10 co-pay | $15 co-pay –covered in full after 30 visits $15 co-pay | $15 co-pay –covered in full after 24 visits $15 co-pay | 30% co-insurance* |
| preventive care | $0 co-pay | $0 co-pay | $0 co-pay | 30% co-insurance* |
| inpatient hospital - including maternity | 10% co-insurance | 20% co-insurance | 10% co-insurance | 30% co-insurance |
| emergency room visit | $75 co-pay | $100 co-pay | $100 co-pay | $100 co-pay |
| X-ray & lab services | $0 co-pay | $0 co-pay | $0 co-pay | 30% co-insurance |
| outpatient surgery | $10 co-pay | 20% co-insurance | 10% co-insurance | 30% co-insurance |
| alternative care | ||||
| chiropractic | $10 co-pay 20 visit annual limit | $15 co-pay 30 visit annual limit | $15 co-pay 30 visit annual limit | not covered |
| massage | $25 co-pay 12 visit annual limit | $15 co-pay 30 visit annual limit | $15 co-pay 30 visit annual limit | not covered |
| acupuncture | $10 co-pay 12 visit annual limit | $15 co-pay 30 visit annual limit | $15 co-pay 30 visit annual limit | not covered |
| prescription drugs | ||||
| generic | $10 co-pay | $10 co-pay | $15 co-pay | not covered |
| name brand | $20 co-pay | 50% ($150 max) | $30 co-pay | not covered |
| vision benefits | ||||
| exam - every 12-months | $10 co-pay | $10 co-pay | $10 co-pay | see summary |
| contact lenses & frames - every 12-months | $250 benefit | $175 benefit | $175 benefit | see summary |
*deductible waived
Print the side-by-side plan comparison
94806Choose from four dental plans.
| Kaiser | Delta Dental Preventive | Delta Dental Incentive | Delta Dental Constant | |
|---|---|---|---|---|
| dental services | in-network coverage | in-network coverage | in-network coverage | in-network coverage |
| annual max benefit | no max | $2,000 | $2,000 | $2,000 |
| annual deductible | $0 | $50/$100 | $0 | 0% |
| preventive | $5 office co-pay | $0 | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* | 50% |
| basic services | $5 office co-pay | 20% | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* | 50% |
| major services | $5 office co-pay | 30% | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* | 50% |
| ortho - adult | 50% up to $2,000 lifetime | 50% up to $3,000 lifetime | not covered | not covered |
| ortho - child | 50% up to $2,000 lifetime | 50% up to $3,000 lifetime | 50% up to $2,000 lifetime | not covered |
*Requires minimum of one dentist per visit per year to increase and maintain coinsurance level.
Print the side-by-side dental plan comparison
94806Find your employee group below to review plan rates and benefits overview.
FT=Full Time PT=Part Time JS=Job Share
| AFSCME: C-COM |  |  | |
| AFSCME: Department of Transportation and Development (DTD) | | | |
| AFSCME: Water Environment Services (WES) | | | |
| Elected Officials | | | |
| Employees' Association (EA) | | |  |
| Employees' Association Temporary (EA) | | ||
| Federation of Oregon Parole and Probation Officers (FOPPO) | | | |
| Housing Authority Non-Represented | | | |
| Housing Authority Represented | | | |
| Non-Represented Group 1 | | ||
| Non-Represented Group 2 | | | |
| Non-Represented | |
Choose from three medical plans.
| Kaiser | Providence Personal Option | Providence Open Option | ||
|---|---|---|---|---|
| medical services | in-network coverage only | in-network coverage only | in-network | out of network |
| annual deductible - single/family | $0 | $0 | $50/$150 | |
| annual out of pocket max - single/family | $600/$1,200 | $1,000/$3,000 | $2,000/$6,000 | |
| office visit - primary, specialty, urgent care | $10 co-pay | $15 co-pay | $10 co-pay | 20% co-insurance* |
| preventive care | $0 co-pay | $0 co-pay | $0 co-pay | 20% co-insurance* |
| inpatient hospital - including maternity | covered in full | covered in full | covered in full | 20% co-insurance |
| emergency room visit | $75 co-pay | $100 co-pay | $100 co-pay | $100 co-pay |
| X-ray & lab services | covered in full | covered in full | covered in full | 20% co-insurance |
| outpatient surgery | $10 co-pay | covered in full | $10 co-pay | 20% co-insurance |
| alternative care | ||||
| chiropractic | $10 co-pay 20 visit annual limit | $10 co-pay 30 visit annual limit | $10 co-pay 30 visit annual limit | not covered |
| massage | $25 co-pay 12 visit annual limit | $10 co-pay 30 visit annual limit | $10 co-pay 30 visit annual limit | not covered |
| acupuncture | $10 co-pay 12 visit annual limit | $10 co-pay 30 visit annual limit | $10 co-pay 30 visit annual limit | not covered |
| prescription drugs | ||||
| generic | $10 co-pay | $10 co-pay | $10 co-pay | not covered |
| name brand | $20 co-pay | $15 co-pay | $15 co-pay | not covered |
| vision benefits | ||||
| exam - every 12-months | $10 co-pay | $10 co-pay | $10 co-pay | see summary |
| contact lenses & frames | $200 benefit every 24 months | $175 benefit every 12 months | $175 benefit every 12 months | see summary |
*deductible waived
Print the side-by-side plan comparison
94831Choose from two dental plans.
| Kaiser | Delta Dental Incentive | |
|---|---|---|
| dental services | in-network coverage | in-network coverage |
| annual max benefit | no max | $2,000 |
| annual deductible | $0 | $0 |
| preventive | $5 co-pay | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* |
| basic services | $5 co-pay | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* |
| major services | see plan summary | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* |
| ortho - adult | 50% up to $2,000 lifetime | not covered |
| ortho - child | 50% up to $2,000 lifetime | 50% up to $3,000 lifetime |
*Requires minimum of one dentist per visit per year to increase and maintain coinsurance level.
Print the side-by-side dental plan comparison
94831Find your employee group below to review plan rates and benefits overview.
FT=Full Time PT=Part Time
| Peace Officers Association (POA) | | |
Review side-by-side rate comparison
94831Peace Officers
Choose from three medical plans.
| Kaiser | Providence Personal Option | Providence Open Option | ||
|---|---|---|---|---|
| medical services | in-network coverage only | in-network coverage only | in-network | out of network |
| annual deductible - single/family | $250/$500 | $850/$1,700 | $600/$1,200 | |
| annual out of pocket max - single/family | $1,000/$2,000 | $2,500/$5,000 | $2,000/$4,000 | |
office visit - primary and specialty urgent care | $10 co-pay | $15 co-pay –covered in full after 30 visits $15 co-pay | $15 co-pay –covered in full after 24 visits $15 co-pay | 30% co-insurance* |
| preventive care | $0 co-pay | $0 co-pay | $0 co-pay | 30% co-insurance* |
| inpatient hospital - including maternity | 10% co-insurance | 20% co-insurance | 10% co-insurance | 30% co-insurance |
| emergency room visit | $75 co-pay | $100 co-pay | $100 co-pay | $100 co-pay |
| X-ray & lab services | $0 co-pay | $0 co-pay | $0 co-pay | 30% co-insurance |
| outpatient surgery | $10 co-pay | 20% co-insurance | 10% co-insurance | 30% co-insurance |
| alternative care | ||||
| chiropractic | $10 co-pay 20 visit annual limit | $15 co-pay 30 visit annual limit | $15 co-pay 30 visit annual limit | not covered |
| massage | $25 co-pay 12 visit annual limit | $15 co-pay 30 visit annual limit | $15 co-pay 30 visit annual limit | not covered |
| acupuncture | $10 co-pay 12 visit annual limit | $15 co-pay 30 visit annual limit | $15 co-pay 30 visit annual limit | not covered |
| prescription drugs | ||||
| generic | $10 co-pay | $10 co-pay | $15 co-pay | not covered |
| name brand | $20 co-pay | 50% ($150 max) | $30 co-pay | not covered |
| vision benefits | ||||
| exam - every 12-months | $10 co-pay | $10 co-pay | $10 co-pay | see summary |
| contact lenses & frames - every 12-months | $250 benefit | $175 benefit | $175 benefit | see summary |
*deductible waived
Print the side-by-side plan comparison
94806Choose from four dental plans.
| Kaiser | Delta Dental Preventive | Delta Dental Incentive | Delta Dental Constant | |
|---|---|---|---|---|
| dental services | in-network coverage | in-network coverage | in-network coverage | in-network coverage |
| annual max benefit | no max | $2,000 | $2,000 | $2,000 |
| annual deductible | $0 | $50/$100 | $0 | 0% |
| preventive | $5 office co-pay | $0 | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* | 50% |
| basic services | $5 office co-pay | 20% | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* | 50% |
| major services | $5 office co-pay | 30% | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* | 50% |
| ortho - adult | 50% up to $2,000 lifetime | 50% up to $3,000 lifetime | not covered | not covered |
| ortho - child | 50% up to $2,000 lifetime | 50% up to $3,000 lifetime | 50% up to $2,000 lifetime | not covered |
*Requires minimum of one dentist per visit per year to increase and maintain coinsurance level.
Print the side-by-side dental plan comparison
94806Find your employee group below to review plan rates and benefits overview.
FT=Full Time PT=Part Time JS=Job Share
| AFSCME: C-COM | | | |
| AFSCME: Department of Transportation and Development (DTD) | | | |
| AFSCME: Water Environment Services (WES) | | | |
| Elected Officials | | | |
| Employees' Association (EA) | | | |
| Employees' Association Temporary (EA) | | ||
| Federation of Oregon Parole and Probation Officers (FOPPO) | | | |
| Housing Authority Non-Represented | | | |
| Housing Authority Represented | | | |
| Non-Represented Group 1 | | ||
| Non-Represented Group 2 | | | |
| Non-Represented | |
Choose from three medical plans.
| Kaiser | Providence Personal Option | Providence Open Option | ||
|---|---|---|---|---|
| medical services | in-network coverage only | in-network coverage only | in-network | out of network |
| annual deductible - single/family | $0 | $0 | $50/$150 | |
| annual out of pocket max - single/family | $600/$1,200 | $1,000/$3,000 | $2,000/$6,000 | |
| office visit - primary, specialty, urgent care | $10 co-pay | $15 co-pay | $10 co-pay | 20% co-insurance* |
| preventive care | $0 co-pay | $0 co-pay | $0 co-pay | 20% co-insurance* |
| inpatient hospital - including maternity | covered in full | covered in full | covered in full | 20% co-insurance |
| emergency room visit | $75 co-pay | $100 co-pay | $100 co-pay | $100 co-pay |
| X-ray & lab services | covered in full | covered in full | covered in full | 20% co-insurance |
| outpatient surgery | $10 co-pay | covered in full | $10 co-pay | 20% co-insurance |
| alternative care | ||||
| chiropractic | $10 co-pay 20 visit annual limit | $10 co-pay 30 visit annual limit | $10 co-pay 30 visit annual limit | not covered |
| massage | $25 co-pay 12 visit annual limit | $10 co-pay 30 visit annual limit | $10 co-pay 30 visit annual limit | not covered |
| acupuncture | $10 co-pay 12 visit annual limit | $10 co-pay 30 visit annual limit | $10 co-pay 30 visit annual limit | not covered |
| prescription drugs | ||||
| generic | $10 co-pay | $10 co-pay | $10 co-pay | not covered |
| name brand | $20 co-pay | $15 co-pay | $15 co-pay | not covered |
| vision benefits | ||||
| exam - every 12-months | $10 co-pay | $10 co-pay | $10 co-pay | see summary |
| contact lenses & frames | $200 benefit every 24 months | $175 benefit every 12 months | $175 benefit every 12 months | see summary |
*deductible waived
Print the side-by-side plan comparison
94831Choose from two dental plans.
| Kaiser | Delta Dental Incentive | |
|---|---|---|
| dental services | in-network coverage | in-network coverage |
| annual max benefit | no max | $2,000 |
| annual deductible | $0 | $0 |
| preventive | $5 co-pay | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* |
| basic services | $5 co-pay | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* |
| major services | see plan summary | 1st year - 30%* 2nd year - 20%* 3rd year - 10%* 4th year - 0%* |
| ortho - adult | 50% up to $2,000 lifetime | not covered |
| ortho - child | 50% up to $2,000 lifetime | 50% up to $3,000 lifetime |
*Requires minimum of one dentist per visit per year to increase and maintain coinsurance level.
Print the side-by-side dental plan comparison
94831Find your employee group below to review plan rates and benefits overview.
FT=Full Time PT=Part Time
| Peace Officers Association (POA) | | |
Review side-by-side rate comparison
94831Other County-Paid Benefits
In addition to life insurance, short-term disability, long-term disability and wellness program activities and events, the county benefits package includes the following county-paid benefits
Voluntary Benefit Options
Below are additional benefits you can select and pay for if they fit your needs. You can enroll in voluntary benefits as a new hire or during the annual open enrollment period.
