Welcome to AGC Health Benefit Trust
Oregon Columbia Chapter
2021
Program Overview
Overview
Product Grid
Underwriting Guidelines
Member Contact Information
Vimly Administration Guide
Prior year summaries, forms, etc available on request.
Customer Service
Autumn Schwerdfager – Senior Account Manager
cell: 503.462.4041
direct: 503.977.5704
fax: 360.735.3144
toll-free: 800.735.8325
e: service@agchealthplansnw.com
Quoting & Submission Materials
Quoting Materials
Submission Materials
- Submission Checklist
- Employer Application
- Employee Enrollment Form
- Enrollment Census Template
- SBC Acknowledgement Form
- Late Submission Letter
- EFT Authorization Form
- Vimly COBRA Administrative Agreement
Dollar Bank
CDHP Administration Forms available upon request to: flexspending@vimly.com
Medical/RX – Regence
Summaries
- PPO $500 RX 1
- PPO $500 RX 2
- PPO $500 RX 3
- PPO $1,000 RX 1
- PPO $1,000 RX 2
- PPO $1,000 RX 3
- PPO $1,500 RX 1
- PPO $1,500 RX 2
- PPO $1,500 RX 3
- PPO $2,000 RX 1
- PPO $2,000 RX 2
- PPO $2,000 RX 3
- PPO $3,000 RX 1
- PPO $3,000 RX 2
- PPO $3,000 RX 3
- HSA $2,500 RX 30%
- HSA 4500
- Value $500 RX 1
- Value $500 RX 2
- Value $500 RX 3
- Value $1,000 RX 1
- Value $1,000 RX 2
- Value $1,000 RX 3
- Value $2,500 RX 1
- Value $2,500 RX 2
- Value $2,500 RX 3
- Value $3,500 RX 1
- Value $3,500 RX 2
- Value $3,500 RX 3
- Value $5,000 RX 1
- Value $5,000 RX 2
- Value $5,000 RX 3
- Value $6,000 RX 1
- Value $6,000 RX 2
- Value $6,000 RX 3
SBC’s
- PPO $500 RX 1
- PPO $500 RX 2
- PPO $500 RX 3
- PPO $1,000 RX 1
- PPO $1,000 RX 2
- PPO $1,000 RX 3
- PPO $1,500 RX 1
- PPO $1,500 RX 2
- PPO $1,500 RX 3
- PPO $2,000 RX 1
- PPO $2,000 RX 2
- PPO $2,000 RX 3
- PPO $3,000 RX 1
- PPO $3,000 RX 2
- PPO $3,000 RX 3
- HSA $2,500 RX 30%
- HSA 4500
- Value $500 RX 1
- Value $500 RX 2
- Value $500 RX 3
- Value $1,000 RX 1
- Value $1,000 RX 2
- Value $1,000 RX 3
- Value $2,500 RX 1
- Value $2,500 RX 2
- Value $2,500 RX 3
- Value $3,500 RX 1
- Value $3,500 RX 2
- Value $3,500 RX 3
- Value $5,000 RX 1
- Value $5,000 RX 2
- Value $5,000 RX 3
- Value $6,000 RX 1
- Value $6,000 RX 2
- Value $6,000 RX 3
Spanish SBC’s available upon request to: service@agchealthplansnw.com.
Contract Booklets
- PPO $500 RX 1
- PPO $500 RX 2
- PPO $500 RX 3
- PPO $1,000 RX 1
- PPO $1,000 RX 2
- PPO $1,000 RX 3
- PPO $1,500 RX 1
- PPO $1,500 RX 2
- PPO $1,500 RX 3
- PPO $2,000 RX 1
- PPO $2,000 RX 2
- PPO $2,000 RX 3
- PPO $3,000 RX 1
- PPO $3,000 RX 2
- PPO $3,000 RX 3
- HSA $2,500 RX 30%
- HSA 4500
- Value $500 RX 1
- Value $500 RX 2
- Value $500 RX 3
- Value $1,000 RX 1
- Value $1,000 RX 2
- Value $1,000 RX 3
- Value $2,500 RX 1
- Value $2,500 RX 2
- Value $2,500 RX 3
- Value $3,500 RX 1
- Value $3,500 RX 2
- Value $3,500 RX 3
- Value $5,000 RX 1
- Value $5,000 RX 2
- Value $5,000 RX 3
- Value $6,000 RX 1
- Value $6,000 RX 2
- Value $6,000 RX 3
Dental – Standard
Links, Forms & Helpful Information
Benefit Summaries
- $1,000 Annual Max
- $1,500 Annual Max
- $2,000 Annual Max
- $1,000 Annual Max with Orthodontia
- $1,500 Annual Max with Orthodontia
- $2,000 Annual Max with Orthodontia
Certificates
Vision – Standard
Links, Forms & Helpful Information
Benefit Summaries
Certificates
Wellness Program and Employee Assistance Program
Wellness Program
- Wellness Flyer – Employers
- Wellness Flyer – Employees
Employee Assistance Program (EAP)
- Employer EAP Flyer
- Employee EAP Flyer
- Employee EAP FAQs
- Legal and Financial Assistance Overview
- Work-Life Website Overview
- EAP Website (BPA Health)
Ancillary Benefits & Programs
Benefit & Program Summaries
- Life/AD&D Benefit Summaries:
- Voluntary Life Summary
- Voluntary Accident Summary
- Travel Assistance Brochure
Certificates
- Life/AD&D Certificate (All Increments of Coverage)
- Voluntary Life Certificate
- Voluntary Accident Certificate