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Oregon Home Mortgage
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Employee Benefit Programs
Documents and Resources January 2023 - December 2023
Providence Health Plan
Balance Gold 1500 Benefit Summary
Balance Gold 2500 Benefit Summary
Essential Dental Benefit Summary
Balance Gold 1500 Summary of Benefits and Coverage
Balance Gold 2500 Summary of Benefits and Coverage
Enrollment/Change Form
Provider directory
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LifeBalance
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ProvRN
Notices
ACA Exchange Model Notice
State Continuation Notice
Medicare Creditable Pharmacy Di
sclosure
Balance Gold 1500
Medicare Creditable Pharmacy Disclosure Balance Gold 2500
Eligibility
30 hours per week on a regularly scheduled basis
Coverage begins first of the month following date of hire
Open enrollment is from Dec 1 through Dec 31 annual for Jan 1 start date
Employer pays 50% for employee only on the Providence Gold 2500 and Essential Dental plan
Employees may enroll dependents on the plan with premium contributions
The Providence Balance Gold 1500, Gold 2500 and Essential Dental plans renew on January 1st each year
IRS Forms
Form W-4
Form I-9
Account Manager and Support Staff Contact Information
Contact Paris Laughlin - Agent
Contact Katie Ostgarden - Account Manager
Contact Sarah Selix - Assistant