Multnomah Bar Association Health Insurance

Table of contents

• Providence Medical: Gold, Silver, and HSA plans
• Kaiser Medical: Gold, Silver, Bronze and HSA plans
• MBA vision and dental plans

MBA Benefit Overview

• MBA Benefit Summary

MBA Proposal Form

• Census Form

New Group Forms

• MBA Adoption Agreement
• MBA Automatic Bank Withdrawal Form

Enrollment Forms

• Providence Signature and Extend Enrollment Form
• Providence Connect and Choice Enrollment Form
• Kaiser Enrollment Form
• Moda Dental Enrollment Form
• Willamette Dental Enrollment Form
• Affidavit of Domestic Partnership or Marriage

• Watch a video review of the Providence Medical Plan
• View the Providence Provider Online Directory

Gold Signature & Extend Plan

• Providence Gold Signature Benefit Summary
• Providence Gold Signature Summary of Benefits and Coverage (SBC)
• Providence Gold Extend Benefit Summary
• Providence Gold Extend Summary of Benefits and Coverage (SBC)
• Member Handbook

Silver Signature & Extend Plan

• Providence Silver Signature Benefit Summary
• Providence Silver Signature Summary of Benefits and Coverage (SBC)
• Providence Silver Extend Benefit Summary
• Providence Silver Extend Summary of Benefits and Coverage (SBC)
• Member Handbook

HSA 3500 Plan

• Providence HSA 3500 Signature Benefit Summary
• Providence HSA 3500 Signature Summary of Benefits and Coverage (SBC)
• Member Handbook

HSA 6650 Plan

• Providence HSA 6650 Signature Benefit Summary
• Providence HSA 6650 Signature Summary of Benefits and Coverage (SBC)
• Member Handbook

Connect Plans

• Providence Platinum Connect Benefit Summary
• Providence Platinum Connect Summary of Benefits and Coverage (SBC)
• Providence Gold Connect Benefit Summary
• Providence Gold Connect Summary of Benefits and Coverage (SBC)
• Member Handbook

Choice Plans

• Providence Platinum Choice Benefit Summary
• Providence Platinum Choice Summary of Benefits and Coverage (SBC)
• Providence Gold Choice Benefit Summary
• Providence Gold Choice Summary of Benefits and Coverage (SBC)
• Member Handbook

Prescription Drugs

• Prescription Drug Plan Summary (for all plans except HSAs)
• View our Drug Formulary
• Pharmacy FAQ

Additional Benefit Information

• Watch a video review of the Kaiser Medical Plan

Gold

• Kaiser Gold Benefit Summary
• Kaiser Gold Summary of Benefits and Coverage (SBC)

Gold PPO (Point-of-Service)

• Kaiser Gold PPO Benefit Summary
• Kaiser Gold PPO Summary of Benefits and Coverage (SBC)

Silver

• Kaiser Silver Benefit Summary
• Kaiser Silver Summary of Benefits and Coverage (SBC)

Bronze

• Kaiser Bronze Benefit Summary
• Kaiser Bronze Summary of Benefits and Coverage (SBC)

HSA

• Kaiser HSA Benefit Summary
• Kaiser HSA Summary of Benefits and Coverage (SBC)

Prescription Drug Information

• Pharmacy Information, Drug Formulary, FAQ
• View our Kaiser Provider Directory

Additional Benefit Information

• Member Enrollment Guide
• Member Discounts Brochure
• Added Choice POS Brochure
• Alternative Care Benefit Summary
• Getting Started With Your Alternative Care Benefit Summary
• Online Services Flyer
• Mental Health Access Points Flyer
• Experience Total Eyecare Brochure
• Understanding Your Cost Flyer

• Watch a video review of the Dental Plan
• Watch a video review of the VSP Vision Plan

MODA Dental

Willamette Dental

Kaiser Dental

• Kaiser Dental Benefit Summary
• Dental Facility Directory

VSP Vision Care

• VSP Benefit Summary
• Exclusive Member Extras
• Eyeconic – Shop Online
• VSP Provider Directory

Compliance Information

• Medicare Part D CMS Filing Notice
• Medicare Part D Creditable Coverage Notice
• Medicare Part D Non-Creditable Coverage Notice
• CHIPRA Notice
• Marketplace Coverage Notice

Policies + Procedures

• MBA Plan Document and Trust Agreement
• MBA Summary Plan Description

Disability Income Insurance

Learn more about our discounted rates on disability insurance and request a quote from our partners at Northwest Mutual. Contact Rob Metler at 503.577.0190 or email at rob.metler@nm.com.

Premium Only & Flex Plan

View the Allegiance Premium Only & Section 125 Flexible Spending Accounts

• Premium Only & Section 125 Flexible Spending Account Fee Schedule
• Premium Only Plan (POP)
  • Set-up Fee $200
  • Annual Fee $100

Long-Term Care Insurance

Interested in long-term care insurance? We recommend getting in touch with Mary Osborn, long-term care specialist.