PacificSource Health Plans

Benefit Summary Guide 2023

PacificSource Health Plans
Group #G0020720
(866)999-5583

Enrollment/Change Form
Health Plan Document
Medical Summary
Rx Summary
Vision Summary

Added Benefits
Members Extras
Continuation of Coverage (COBRA)
Plan Amendment 1 – COVID19 
Care Access Options
Preventive Care Summary
Health Care 101
Member Support Specialists

Required Notices
Medicare D Notice
Privacy Notice