Welcome to AGC Health Benefit Trust
Oregon Columbia Chapter
Customer Service
Autumn Schwerdfager – Program 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 – United Healthcare
Links, Forms & Helpful Information
Summaries
- Premier $500 RX 1
- Premier $500 RX 2
- Premier $500 RX 3
- Premier $500 RX 4
- Premier $1,000 RX 1
- Premier $1,000 RX 2
- Premier $1,000 RX 3
- Premier $1,000 RX 4
- Premier $1,500 RX 1
- Premier $1,500 RX 2
- Premier $1,500 RX 3
- Premier $1,500 RX 4
- Premier $2,000 RX 1
- Premier $2,000 RX 2
- Premier $2,000 RX 3
- Premier $2,000 RX 4
- Premier $3,000 RX 1
- Premier $3,000 RX 2
- Premier $3,000 RX 3
- Premier $3,000 RX 4
- Preferred $500 RX 1
- Preferred $500 RX 2
- Preferred $500 RX 3
- Preferred $500 RX 4
- Preferred $1,000 RX 1
- Preferred $1,000 RX 2
- Preferred $1,000 RX 3
- Preferred $1,000 RX 4
- Preferred $2,500 RX 1
- Preferred $2,500 RX 2
- Preferred $2,500 RX 3
- Preferred $2,500 RX 4
- Preferred $3,500 RX 1
- Preferred $3,500 RX 2
- Preferred $3,500 RX 3
- Preferred $3,500 RX 4
- Preferred $5,000 RX 1
- Preferred $5,000 RX 2
- Preferred $5,000 RX 3
- Preferred $5,000 RX 4
- Preferred $6,000 RX 1
- Preferred $6,000 RX 2
- Preferred $6,000 RX 3
- Preferred $6,000 RX 4
- HSA $2,500 w/ Motion RX 5
- HSA $2,500 w/ Motion RX 6
- HSA $4,500 w/ Motion RX 5
- HSA $4,500 w/ Motion RX 6
- Advanced $500 RX 1
- Advanced $500 RX 2
- Advanced $500 RX 3
- Advanced $500 RX 4
- Advanced $1,000 RX 1
- Advanced $1,000 RX 2
- Advanced $1,000 RX 3
- Advanced $1,000 RX 4
- Advanced $2,000 RX 1
- Advanced $2,000 RX 2
- Advanced $2,000 RX 3
- Advanced $2,000 RX 4
- Advanced $3,000 RX 1
- Advanced $3,000 RX 2
- Advanced $3,000 RX 3
- Advanced $3,000 RX 4
- Advanced $5,000 RX 1
- Advanced $5,000 RX 2
- Advanced $5,000 RX 3
- Advanced $5,000 RX 4
- NexusACO $500 RX 1
- NexusACO $500 RX 2
- NexusACO $500 RX 3
- NexusACO $500 RX 4
- NexusACO $1,000 RX 1
- NexusACO $1,000 RX 2
- NexusACO $1,000 RX 3
- NexusACO $1,000 RX 4
- NexusACO $1,500 RX 1
- NexusACO $1,500 RX 2
- NexusACO $1,500 RX 3
- NexusACO $1,500 RX 4
- NexusACO $2,000 RX 1
- NexusACO $2,000 RX 2
- NexusACO $2,000 RX 3
- NexusACO $2,000 RX 4
- NexusACO $2,500 RX 1
- NexusACO $2,500 RX 2
- NexusACO $2,500 RX 3
- NexusACO $2,500 RX 4
SBC’s
- Premier $500 RX 1
- Premier $500 RX 2
- Premier $500 RX 3
- Premier $500 RX 4
- Premier $1,000 RX 1
- Premier $1,000 RX 2
- Premier $1,000 RX 3
- Premier $1,000 RX 4
- Premier $1,500 RX 1
- Premier $1,500 RX 2
- Premier $1,500 RX 3
- Premier $1,500 RX 4
- Premier $2,000 RX 1
- Premier $2,000 RX 2
- Premier $2,000 RX 3
- Premier $2,000 RX 4
- Premier $3,000 RX 1
- Premier $3,000 RX 2
- Premier $3,000 RX 3
- Premier $3,000 RX 4
- Preferred $500 RX 1
- Preferred $500 RX 2
- Preferred $500 RX 3
- Preferred $500 RX 4
- Preferred $1,000 RX 1
- Preferred $1,000 RX 2
- Preferred $1,000 RX 3
- Preferred $1,000 RX 4
- Preferred $2,500 RX 1
- Preferred $2,500 RX 2
- Preferred $2,500 RX 3
- Preferred $2,500 RX 4
- Preferred $3,500 RX 1
- Preferred $3,500 RX 2
- Preferred $3,500 RX 3
- Preferred $3,500 RX 4
- Preferred $5,000 RX 1
- Preferred $5,000 RX 2
- Preferred $5,000 RX 3
- Preferred $5,000 RX 4
- Preferred $6,000 RX 1
- Preferred $6,000 RX 2
- Preferred $6,000 RX 3
- Preferred $6,000 RX 4
- HSA $2,500 w/Motion RX 5
- HSA $2,500 w/Motion RX 6
- HSA $4,500 w/Motion RX 5
- HSA $4,500 w/Motion RX 6
Spanish SBC’s available upon request to: service@agchealthplansnw.com
SBC’s
- Advanced $500 RX 1
- Advanced $500 RX 2
- Advanced $500 RX 3
- Advanced $500 RX 4
- Advanced $1,000 RX 1
- Advanced $1,000 RX 2
- Advanced $1,000 RX 3
- Advanced $1,000 RX 4
- Advanced $2,000 RX 1
- Advanced $2,000 RX 2
- Advanced $2,000 RX 3
- Advanced $2,000 RX 4
- Advanced $3,000 RX 1
- Advanced $3,000 RX 2
- Advanced $3,000 RX 3
- Advanced $3,000 RX 4
- Advanced $5,000 RX 1
- Advanced $5,000 RX 2
- Advanced $5,000 RX 3
- Advanced $5,000 RX 4
- NexusACO $500 RX 1
- NexusACO $500 RX 2
- NexusACO $500 RX 3
- NexusACO $500 RX 4
- NexusACO $1,000 RX 1
- NexusACO $1,000 RX 2
- NexusACO $1,000 RX 3
- NexusACO $1,000 RX 4
- NexusACO $1,500 RX 1
- NexusACO $1,500 RX 2
- NexusACO $1,500 RX 3
- NexusACO $1,500 RX 4
- NexusACO $2,000 RX 1
- NexusACO $2,000 RX 2
- NexusACO $2,000 RX 3
- NexusACO $2,000 RX 4
- NexusACO $2,500 RX 1
- NexusACO $2,500 RX 2
- NexusACO $2,500 RX 3
- NexusACO $2,500 RX 4
Spanish SBC’s available upon request to: service@agchealthplansnw.com
Medical/RX – United Healthcare
Links, Forms & Helpful Information
Summaries
- Premier $500
- Premier $1,000
- Premier $1,500
- Premier $2,000
- Premier $3,000
- Preferred $500
- Preferred $1,000
- Preferred $2,500
- Preferred $3,500
- Preferred $5,000
- Preferred $6,000
- HSA $2,500 w/Motion
- HSA $4,500 w/ Motion
- RX1
- RX2
- RX3
- RX4
- RX5 (HSA)
- RX6 (HSA)
- NexusACO 500 RX 1
- NexusACO 500 RX 2
- NexusACO 500 RX 3
- NexusACO 500 RX 4
- NexusACO 1000 RX 1
- NexusACO 1000 RX 2
- NexusACO 1000 RX 3
- NexusACO 1000 RX 4
- NexusACO 1500 RX 1
- NexusACO 1500 RX 2
- NexusACO 1500 RX 3
- NexusACO 1500 RX 4
- NexusACO 2000 RX 1
- NexusACO 2000 RX 2
- NexusACO 2000 RX 3
- NexusACO 2000 RX 4
- NexusACO 2500 RX 1
- NexusACO 2500 RX 2
- NexusACO 2500 RX 3
- NexusACO 2500 RX 4
SBC’s
- Premier $500 RX 1
- Premier $500 RX 2
- Premier $500 RX 3
- Premier $500 RX 4
- Premier $1,000 RX 1
- Premier $1,000 RX 2
- Premier $1,000 RX 3
- Premier $1,000 RX 4
- Premier $1,500 RX 1
- Premier $1,500 RX 2
- Premier $1,500 RX 3
- Premier $1,500 RX 4
- Premier $2,000 RX 1
- Premier $2,000 RX 2
- Premier $2,000 RX 3
- Premier $2,000 RX 4
- Premier $3,000 RX 1
- Premier $3,000 RX 2
- Premier $3,000 RX 3
- Premier $3,000 RX 4
- Preferred $500 RX 1
- Preferred $500 RX 2
- Preferred $500 RX 3
- Preferred $500 RX 4
- Preferred $1,000 RX 1
- Preferred $1,000 RX 2
- Preferred $1,000 RX 3
- Preferred $1,000 RX 4
Spanish SBC’s available upon request to: service@agchealthplansnw.com
SBC’s
- Preferred $2,500 RX 1
- Preferred $2,500 RX 2
- Preferred $2,500 RX 3
- Preferred $2,500 RX 4
- Preferred $3,500 RX 1
- Preferred $3,500 RX 2
- Preferred $3,500 RX 3
- Preferred $3,500 RX 4
- Preferred $5,000 RX 1
- Preferred $5,000 RX 2
- Preferred $5,000 RX 3
- Preferred $5,000 RX 4
- Preferred $6,000 RX 1
- Preferred $6,000 RX 2
- Preferred $6,000 RX 3
- Preferred $6,000 RX 4
- HSA $2,500 w/Motion RX 5
- HSA $2,500 w/Motion RX 6
- HSA $4,500 w/Motion RX 5
- HSA $4,500 w/Motion RX 6
- NexusACO 500 – RX 1
- NexusACO 500 – RX 2
- NexusACO 500 – RX 3
- NexusACO 500 – RX 4
- NexusACO 1000 – RX 1
- NexusACO 1000 – RX 2
- NexusACO 1000 – RX 3
- NexusACO 1000 – RX 4
- NexusACO 1500 – RX 1
- NexusACO 1500 – RX 2
- NexusACO 1500 – RX 3
- NexusACO 1500 – RX 4
- NexusACO 2000 – RX 1
- NexusACO 2000 – RX 2
- NexusACO 2000 – RX 3
- NexusACO 2000 – RX 4
- NexusACO 2500 – RX 1
- NexusACO 2500 – RX 2
- NexusACO 2500 – RX 3
- NexusACO 2500 – RX 4
Spanish SBC’s available upon request to: service@agchealthplansnw.com
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