CERTIFIED MEDICAL QUALIFIED HEALTH PLANS (QHP) FOR GROUPS January 1, 2015 December 31, 2015

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1 CERTIFIED MEDICAL QUALIFIED HEALTH PLANS (QHP) FOR GROUPS January 1, 2015 December 31, 2015 METAL TIER ATRIO Oregon Standard Bronze Plan 32536OR Bronze ATRIO Bronze Pioneer 32536OR Bronze ATRIO Oregon Standard Silver Plan 32536OR Silver ATRIO Silver Pioneer 32536OR Silver ATRIO Oregon Standard Gold Plan 32536OR Gold ATRIO Gold Pioneer 32536OR Gold METAL TIER Health Republic Oregon Standard Bronze Plan 96383OR Bronze PrimaryCare Bronze Plan 96383OR Bronze Key Care Bronze Plan 96383OR Bronze HSA Bronze Plan 96383OR Bronze Health Republic Oregon Standard Silver Plan 96383OR Silver PrimaryCare Silver Plan 96383OR Silver FoundationCare Silver Plan 96383OR Silver Key Care Silver Plan 96383OR Silver CoreCare Silver Plan 96383OR Silver Health Republic Oregon Standard Gold Plan 96383OR Gold PrimaryCare Gold Plan 96383OR Gold FoundationCare Gold Plan 96383OR Gold CoreCare Gold Plan 96383OR Gold HSA Gold Plan 96383OR Gold FoundationCare Platinum Plan 96383OR Platinum CoreCare Platinum Plan 96383OR Platinum CO-O GROUP (11/14) 1

2 METAL TIER KP OR Bronze 3500/ OR Bronze KP OR Bronze 4500/ OR Bronze KP OR Silver 0/ OR Silver KP OR Silver 1500/ OR Silver KP OR Silver 2000/ OR Silver Kaiser Permanente Oregon Standard Silver Plan 71287OR Silver KP OR Silver 1750/25% H.S.A 71287OR Silver KP OR Gold 0/ OR Gold KP OR Gold 500/ OR Gold KP OR Gold 1000/ OR Gold Kaiser Permanente Oregon Standard Gold Plan 71287OR Gold KP OR Platinum 0/ OR Platinum KP OR Platinum 250/ OR Platinum METAL TIER Beneficial OR Bronze Focus 5000 Rose City 39424OR Bronze HSA OR Bronze HSA OR Bronze Moda Health Oregon Standard Bronze Plan 39424OR Bronze Moda Health Oregon Standard Silver Plan 39424OR Silver PPO OR Silver Value OR Silver Beneficial OR Silver Focus 2000 Rose City 39424OR Silver Moda Health Oregon Standard Gold Plan 39424OR Gold PPO OR Gold PPO 1000A 39424OR Gold PPO 1000B 39424OR Gold PPO OR Gold CO-O GROUP (11/14) 2

3 METAL TIER Oregon s Health CO-OP SiMPLE Bronze 99389OR Bronze Oregon s Health CO-OP Oregon Standard Bronze Plan 99389OR Bronze Oregon s Health CO-OP SiMPLE Silver 99389OR Silver Oregon s Health CO-OP SiMPLE Silver HSA 99389OR Silver Oregon s Health CO-OP Oregon Standard Silver Plan 99389OR Silver Oregon s Health CO-OP SiMPLE Gold 99389OR Gold Oregon s Health CO-OP Oregon Standard Gold Plan 99389OR Gold Oregon s Health CO-OP SiMPLE Platinum 99389OR Platinum METAL TIER Value Bronze PSN OR Bronze Value Bronze PSN OR Bronze SmartChoice Value Bronze OR Bronze SmartChoice Value Bronze OR Bronze SmartHealth Value Bronze OR Bronze SmartHealth Value Bronze OR Bronze Balance Bronze PSN OR Bronze SmartChoice Balance Bronze OR Bronze SmartHealth Balance Bronze OR Bronze PacificSource Oregon Standard Bronze Plan PSN 10091OR Bronze PacificSource Oregon Standard Bronze Plan SCN 10091OR Bronze PacificSource Oregon Standard Bronze Plan SHN 10091OR Bronze Value Silver PSN OR Silver Value Silver PSN OR Silver SmartChoice Value Silver OR Silver SmartChoice Value Silver OR Silver SmartHealth Value Silver OR Silver SmartHealth Value Silver OR Silver Balance Silver PSN 1500 ACV 10091OR Silver Balance Silver PSN 2000 ACV 10091OR Silver SmartHealth Balance Silver 1500 ACV 10091OR Silver CO-O GROUP (11/14) 3

4 SmartHealth Balance Silver 2000 ACV 10091OR Silver SmartChoice Balance Silver 1500 ACV 10091OR Silver SmartChoice Balance Silver 2000 ACV 10091OR Silver PacificSource Oregon Standard Silver Plan PSN 10091OR Silver PacificSource Oregon Standard Silver Plan SCN 10091OR Silver PacificSource Oregon Standard Silver Plan SHN 10091OR Silver Balance Gold PSN 1000 ACV 10091OR Gold SmartHealth Balance Gold 500 ACV 10091OR Gold SmartChoice Balance Gold 1000 ACV 10091OR Gold PacificSource Oregon Standard Gold Plan PSN 10091OR Gold PacificSource Oregon Standard Gold Plan SCN 10091OR Gold PacificSource Oregon Standard Gold Plan SHN 10091OR Gold METAL TIER Providence Oregon Standard Bronze Plan 56707OR Bronze Providence Oregon Standard Silver Plan 56707OR Silver Providence Oregon Standard Gold Plan 56707OR Gold METAL TIER Trillium Oregon Standard Bronze Plan Active 95417OR Bronze Trillium Oregon Standard Silver Plan Active 95417OR Silver Trillium Oregon Standard Gold Plan Active 95417OR Gold CO-O GROUP (11/14) 4

5 CERTIFIED DENTAL QUALIFIED HEALTH PLANS (QHP) FOR GROUPS January 1, 2015 December 31, 2015 BEST Dental Value BEST Dental Choice-L BEST Dental Standard-L BEST Dental Choice-H BEST Dental Standard-H BEST Dental Premium 97876OR OR OR OR OR OR SuperChoice SuperChoice Plus SuperChoice Enhanced 25486OR OR OR Dentegra Dental PPO for Small Businesses Pediatric Basic Plan Dentegra Dental PPO for Small Businesses Family Basic Plan Dentegra Dental PPO for Small Businesses Family Preferred Plan 68420OR OR OR CO-O GROUP (11/14) 5

6 Guardian Family Advantage Guardian Family Essentials 23484OR OR YV YU YW 71287OR OR OR Delta Dental PPO Low Delta Dental PPO High 28415OR OR Kids Dental Advantage 0/20/50 Dental Advantage Core Dental Advantage Essentials Core 10091OR OR OR CO-O GROUP (11/14) 6

7 Trillium Smiles Pediatric Low Trillium Smiles Family Dental Low Trillium Smiles Pediatric High Trillium Smiles Family Dental High 95417OR OR OR OR TotalCare Oregon Plan 1 TotalCare Oregon Plan OR OR CO-O GROUP (11/14) 7