Employee Benefit Plans

Vigilant Group Benefits Trust (VGBT) provides high quality, affordable employee benefits programs to employers in the manufacturing industry, located in Oregon.

Groups may choose from several medical plan options underwritten by Regence BlueCross BlueShield of Oregon, and may also elect optional dental coverage through Moda (underwritten by Oregon Dental Service).

Benefit Plan Documents & Forms

Enrollment Forms

• Group Master Application 2018
• Employee Enrollment Form 2018
• Group Master Application 2017
• Employee Enrollment Form 2017
• Census Enrollment Template

General Information

• Multiple Plan Selection Matrix
• Contact List
• New Business & Renewal Checklist
• Quote Request Checklist
• Health Equity Agreement for HSA Plans
• VGBT Plans - Creditable Coverage Status
• Creditable Coverage Notice
• Notice of Privacy Practices
• VGBT 2018 SPD
• EFT Authorization Form

Medical Plan Summaries

Effective January 1, 2018 - December 31, 2018

Regence BlueCross BlueShield of Oregon
A Series, B Series, D Series

• VGBT Plan Menu

• A Plans
  PPO Plan A | $500
  PPO Plan A | $1000
  PPO Plan A | $1500
  PPO Plan A | $2000
  PPO Plan A | $2500
  PPO Plan A | $3500
  PPO Plan A | $5000
• B Plans
  PPO Plan B | $500
  PPO Plan B | $1000
  PPO Plan B | $1500
  PPO Plan B | $2000
  PPO Plan B | $2500
  PPO Plan B | $3500
  PPO Plan B | $5000
• D Plans
  PPO Plan D | $1500
  PPO Plan D | $2500
  PPO Plan D | $3500
  PPO Plan D | $5000

Medical Plan Booklets

Effective January 1, 2018 - December 31, 2018

Regence BlueCross BlueShield of Oregon
A Series, B Series, HSA Series, Vision Rider available on all medical plans

• A Plans
  PPO Plan A | $500
  PPO Plan A | $1000
  PPO Plan A | $1500
  PPO Plan A | $2000
  PPO Plan A | $2500
  PPO Plan A | $3500
  PPO Plan A | $5000
• B Plans
  PPO Plan B | $500
  PPO Plan B | $1000
  PPO Plan B | $1500
  PPO Plan B | $2000
  PPO Plan B | $2500
  PPO Plan B | $3500
  PPO Plan B | $5000
• D Plans
  PPO Plan D | $1500
  PPO Plan D | $2500
  PPO Plan D | $3500
  PPO Plan D | $5000

Medical Plan Summaries

Effective January 1, 2017 - December 31, 2017

Regence BlueCross BlueShield of Oregon
A Series, B Series, D Series, Active Care Series

• VGBT Plan Menu
• Medical Plan Comparisons: A Plans
• Medical Plan Comparisons: B Plans
• Medical Plan Comparisons: D Plans
• Medical Plan Comparisons: Active Care Plans

• A Plans
  PPO Plan A | $500
  PPO Plan A | $1000
  PPO Plan A | $1500
  PPO Plan A | $2000
  PPO Plan A | $2500
  PPO Plan A | $3500
  PPO Plan A | $5000
• B Plans
  PPO Plan B | $500
  PPO Plan B | $1000
  PPO Plan B | $1500
  PPO Plan B | $2000
  PPO Plan B | $2500
  PPO Plan B | $3500
  PPO Plan B | $5000
• D Plans
  PPO Plan D | $1500
  PPO Plan D | $2500
  PPO Plan D | $3500
  PPO Plan D | $5000
• Active Care Plans
  ACO $500
  ACO $1000
  ACO $2000
  ACO $5000

Medical Plan Booklets

Effective January 1, 2017 - December 31, 2017

Regence BlueCross BlueShield of Oregon
A Series, B Series, HSA Series, Active Care Series, Vision Rider available on all medical plans

• A Plans
  PPO Plan A | $500
  PPO Plan A | $1000
  PPO Plan A | $1500
  PPO Plan A | $2000
  PPO Plan A | $2500
  PPO Plan A | $3500
  PPO Plan A | $5000
• B Plans
  PPO Plan B | $500
  PPO Plan B | $1000
  PPO Plan B | $1500
  PPO Plan B | $2000
  PPO Plan B | $2500
  PPO Plan B | $3500
  PPO Plan B | $5000
• D Plans
  HSA Plan D | $1500
  HSA Plan D | $2500
  HSA Plan D | $3500
  HSA Plan D | $5000
• Active Care Plans
  ACO $500
  ACO $1000
  ACO $2000
  ACO $5000

Dental Plan Summaries

Effective January 1, 2018 - December 31, 2018

Delta Dental

• Plan 1
• Plan 2
• Plan 3
• Plan 4
• Orthodontia

Vision Plan Summaries

VSP

• Plan 1
• Plan 2
• Plan 3

Employee Assistance Program (EAP)

Reliant Behavioral Health

• EAP Benefit Overview
• 3-Visit
• 6-Visit

Life/AD&D Plan Summaries

LifeMap

• $10k Life/AD&D
• $15k Life/AD&D
• $25 Life/AD&D

Medical Plan Booklets

Effective January 1, 2016 - December 31, 2016

Regence BlueCross BlueShield of Oregon
A Series, B Series, HSA Series, Active Care Series, Vision Rider available on all medical plans

• A Plans
  PPO Plan A | $500
  PPO Plan A | $500 with Vision
  PPO Plan A | $1000
  PPO Plan A | $1000 with Vision
  PPO Plan A | $1500
  PPO Plan A | $1500 with Vision
  PPO Plan A | $2000
  PPO Plan A | $2000 with Vision
  PPO Plan A | $2500
  PPO Plan A | $2500 with Vision
  PPO Plan A | $3500
  PPO Plan A | $3500 with Vision
  PPO Plan A | $5000
  PPO Plan A | $5000 with Vision
• B Plans
  PPO Plan B | $500
  PPO Plan B | $500
  PPO Plan B | $500 with Vision
  PPO Plan B | $1000
  PPO Plan B | $1000 with Vision
  PPO Plan B | $1500
  PPO Plan B | $1500 with Vision
  PPO Plan B | $2000
  PPO Plan B | $2000 with Vision
  PPO Plan B | $2500
  PPO Plan B | $2500 with Vision
  PPO Plan B | $3500
  PPO Plan B | $3500 with Vision
  PPO Plan B | $5000
  PPO Plan B | $5000 with Vision
• D Plans
  HSA Plan D | $1500
  HSA Plan D | $1500
  HSA Plan D | $1500 with Vision
  HSA Plan D | $2500
  HSA Plan D | $2500 with Vision
  HSA Plan D | $3500
  HSA Plan D | $3500 with Vision
  HSA Plan D | $5000
  HSA Plan D | $5000 with Vision
• Active Care Plans
  ACO $500
  ACO $500
  ACO $500 with Vision
  ACO $1000
  ACO $1000 with Vision
  ACO $2000
  ACO $2000 with Vision
  ACO $5000
  ACO $5000 with Vision