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Providers | Application
Plan Benefits:
Diamond 15 | Pearl 25 HMO
| Emerald 40 | Crystal 80 HDHP | Crystal 100 HDHP
Plan Rates:
Diamond 15 | Pearl 25 HMO | Emerald 40 | Crystal 80 HDHP | Crystal 100 HDHP
LifeWise Health Plans of Oregon
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Other Insurance
Oregon Medical Insurance > Diamond 15 >
Effective date : 10/1/2009
Valid thru : 9/30/2010
Counties : Baker, Clatsop, Columbia, Coos, Crook, Curry, Douglas, Gilliam, Grant, Harney, Hood River, Jackson, Jefferson, Josephine, Lincoln, Malheur, Morrow, Sherman, Tillamook, Umatilla, Union, Wallowa, Wasco, Wheeler
| Family Status : | Applicant | Applicant and Spouse | Applicant and Child(ren) | Applicant and Family |
| Age | Deductible : 250 | |||
| 0-2 | 265.00 | N/A | N/A | N/A |
| 3-18 | 204.00 | N/A | N/A | N/A |
| 19-24 | 258.00 | 516.00 | 387.00 | 723.00 |
| 25-29 | 279.00 | 558.00 | 419.00 | 837.00 |
| 30-34 | 320.00 | 640.00 | 480.00 | 912.00 |
| 35-39 | 340.00 | 680.00 | 510.00 | 969.00 |
| 40-44 | 439.00 | 878.00 | 659.00 | 1054.00 |
| 45-49 | 527.00 | 1054.00 | 791.00 | 1265.00 |
| 50-54 | 611.00 | 1222.00 | 905.00 | 1406.00 |
| 55-59 | 740.00 | 1480.00 | 999.00 | 1628.00 |
| 60-64 | 850.00 | 1700.00 | 1105.00 | 1870.00 |
| 65+ | 951.00 | 1902.00 | 1218.00 | 2093.00 |
| Age | Deductible : 500 | |||
| 0-2 | 248.00 | N/A | N/A | N/A |
| 3-18 | 191.00 | N/A | N/A | N/A |
| 19-24 | 241.00 | 482.00 | 362.00 | 675.00 |
| 25-29 | 261.00 | 522.00 | 392.00 | 783.00 |
| 30-34 | 298.00 | 596.00 | 447.00 | 850.00 |
| 35-39 | 318.00 | 636.00 | 477.00 | 907.00 |
| 40-44 | 410.00 | 820.00 | 615.00 | 984.00 |
| 45-49 | 492.00 | 984.00 | 738.00 | 1181.00 |
| 50-54 | 570.00 | 1140.00 | 844.00 | 1311.00 |
| 55-59 | 690.00 | 1380.00 | 932.00 | 1518.00 |
| 60-64 | 793.00 | 1586.00 | 1031.00 | 1745.00 |
| 65+ | 887.00 | 1774.00 | 1136.00 | 1952.00 |
| Age | Deductible : 1000 | |||
| 0-2 | 232.00 | N/A | N/A | N/A |
| 3-18 | 179.00 | N/A | N/A | N/A |
| 19-24 | 226.00 | 452.00 | 339.00 | 633.00 |
| 25-29 | 244.00 | 488.00 | 366.00 | 732.00 |
| 30-34 | 279.00 | 558.00 | 419.00 | 796.00 |
| 35-39 | 297.00 | 594.00 | 446.00 | 847.00 |
| 40-44 | 383.00 | 766.00 | 575.00 | 920.00 |
| 45-49 | 460.00 | 920.00 | 690.00 | 1104.00 |
| 50-54 | 533.00 | 1066.00 | 789.00 | 1226.00 |
| 55-59 | 646.00 | 1292.00 | 873.00 | 1422.00 |
| 60-64 | 742.00 | 1484.00 | 965.00 | 1633.00 |
| 65+ | 830.00 | 1660.00 | 1063.00 | 1826.00 |
| Age | Deductible : 2500 | |||
| 0-2 | 197.00 | N/A | N/A | N/A |
| 3-18 | 152.00 | N/A | N/A | N/A |
| 19-24 | 192.00 | 384.00 | 288.00 | 538.00 |
| 25-29 | 207.00 | 414.00 | 311.00 | 621.00 |
| 30-34 | 237.00 | 474.00 | 356.00 | 676.00 |
| 35-39 | 252.00 | 504.00 | 378.00 | 719.00 |
| 40-44 | 325.00 | 650.00 | 488.00 | 780.00 |
| 45-49 | 391.00 | 782.00 | 587.00 | 939.00 |
| 50-54 | 452.00 | 904.00 | 669.00 | 1040.00 |
| 55-59 | 548.00 | 1096.00 | 740.00 | 1206.00 |
| 60-64 | 630.00 | 1260.00 | 819.00 | 1386.00 |
| 65+ | 705.00 | 1410.00 | 903.00 | 1551.00 |
| Age | Deductible : 5000 | |||
| 0-2 | 163.00 | N/A | N/A | N/A |
| 3-18 | 126.00 | N/A | N/A | N/A |
| 19-24 | 159.00 | 318.00 | 239.00 | 446.00 |
| 25-29 | 172.00 | 344.00 | 258.00 | 516.00 |
| 30-34 | 197.00 | 394.00 | 296.00 | 562.00 |
| 35-39 | 209.00 | 418.00 | 314.00 | 596.00 |
| 40-44 | 259.00 | 518.00 | 389.00 | 622.00 |
| 45-49 | 305.00 | 610.00 | 458.00 | 732.00 |
| 50-54 | 372.00 | 744.00 | 551.00 | 856.00 |
| 55-59 | 439.00 | 878.00 | 593.00 | 966.00 |
| 60-64 | 501.00 | 1002.00 | 652.00 | 1103.00 |
| 65+ | 584.00 | 1168.00 | 748.00 | 1285.00 |
| Age | Deductible : 7500 | |||
| 0-2 | 139.00 | N/A | N/A | N/A |
| 3-18 | 115.00 | N/A | N/A | N/A |
| 19-24 | 135.00 | 270.00 | 203.00 | 378.00 |
| 25-29 | 146.00 | 292.00 | 219.00 | 438.00 |
| 30-34 | 165.00 | 330.00 | 248.00 | 471.00 |
| 35-39 | 173.00 | 346.00 | 260.00 | 494.00 |
| 40-44 | 210.00 | 420.00 | 315.00 | 504.00 |
| 45-49 | 248.00 | 496.00 | 372.00 | 596.00 |
| 50-54 | 303.00 | 606.00 | 449.00 | 697.00 |
| 55-59 | 355.00 | 710.00 | 480.00 | 781.00 |
| 60-64 | 407.00 | 814.00 | 530.00 | 896.00 |
| 65+ | 484.00 | 968.00 | 620.00 | 1065.00 |
Counties : Deschutes, Klamath, Lake
| Family Status : | Applicant | Applicant and Spouse | Applicant and Child(ren) | Applicant and Family |
| Age | Deductible : 250 | |||
| 0-2 | 265.00 | N/A | N/A | N/A |
| 3-18 | 204.00 | N/A | N/A | N/A |
| 19-24 | 258.00 | 516.00 | 387.00 | 723.00 |
| 25-29 | 279.00 | 558.00 | 419.00 | 837.00 |
| 30-34 | 320.00 | 640.00 | 480.00 | 912.00 |
| 35-39 | 340.00 | 680.00 | 510.00 | 969.00 |
| 40-44 | 439.00 | 878.00 | 659.00 | 1054.00 |
| 45-49 | 527.00 | 1054.00 | 791.00 | 1265.00 |
| 50-54 | 611.00 | 1222.00 | 905.00 | 1406.00 |
| 55-59 | 740.00 | 1480.00 | 999.00 | 1628.00 |
| 60-64 | 850.00 | 1700.00 | 1105.00 | 1870.00 |
| 65+ | 951.00 | 1902.00 | 1218.00 | 2093.00 |
| Age | Deductible : 500 | |||
| 0-2 | 248.00 | N/A | N/A | N/A |
| 3-18 | 191.00 | N/A | N/A | N/A |
| 19-24 | 241.00 | 482.00 | 362.00 | 675.00 |
| 25-29 | 261.00 | 522.00 | 392.00 | 783.00 |
| 30-34 | 298.00 | 596.00 | 447.00 | 850.00 |
| 35-39 | 318.00 | 636.00 | 477.00 | 907.00 |
| 40-44 | 410.00 | 820.00 | 615.00 | 984.00 |
| 45-49 | 492.00 | 984.00 | 738.00 | 1181.00 |
| 50-54 | 570.00 | 1140.00 | 844.00 | 1311.00 |
| 55-59 | 690.00 | 1380.00 | 932.00 | 1518.00 |
| 60-64 | 793.00 | 1586.00 | 1031.00 | 1745.00 |
| 65+ | 887.00 | 1774.00 | 1136.00 | 1952.00 |
| Age | Deductible : 1000 | |||
| 0-2 | 232.00 | N/A | N/A | N/A |
| 3-18 | 179.00 | N/A | N/A | N/A |
| 19-24 | 226.00 | 452.00 | 339.00 | 633.00 |
| 25-29 | 244.00 | 488.00 | 366.00 | 732.00 |
| 30-34 | 279.00 | 558.00 | 419.00 | 796.00 |
| 35-39 | 297.00 | 594.00 | 446.00 | 847.00 |
| 40-44 | 383.00 | 766.00 | 575.00 | 920.00 |
| 45-49 | 460.00 | 920.00 | 690.00 | 1104.00 |
| 50-54 | 533.00 | 1066.00 | 789.00 | 1226.00 |
| 55-59 | 646.00 | 1292.00 | 873.00 | 1422.00 |
| 60-64 | 742.00 | 1484.00 | 965.00 | 1633.00 |
| 65+ | 830.00 | 1660.00 | 1063.00 | 1826.00 |
| Age | Deductible : 2500 | |||
| 0-2 | 197.00 | N/A | N/A | N/A |
| 3-18 | 152.00 | N/A | N/A | N/A |
| 19-24 | 192.00 | 384.00 | 288.00 | 538.00 |
| 25-29 | 207.00 | 414.00 | 311.00 | 621.00 |
| 30-34 | 237.00 | 474.00 | 356.00 | 676.00 |
| 35-39 | 252.00 | 504.00 | 378.00 | 719.00 |
| 40-44 | 325.00 | 650.00 | 488.00 | 780.00 |
| 45-49 | 391.00 | 782.00 | 587.00 | 939.00 |
| 50-54 | 452.00 | 904.00 | 669.00 | 1040.00 |
| 55-59 | 548.00 | 1096.00 | 740.00 | 1206.00 |
| 60-64 | 630.00 | 1260.00 | 819.00 | 1386.00 |
| 65+ | 705.00 | 1410.00 | 903.00 | 1551.00 |
| Age | Deductible : 5000 | |||
| 0-2 | 163.00 | N/A | N/A | N/A |
| 3-18 | 126.00 | N/A | N/A | N/A |
| 19-24 | 159.00 | 318.00 | 239.00 | 446.00 |
| 25-29 | 172.00 | 344.00 | 258.00 | 516.00 |
| 30-34 | 197.00 | 394.00 | 296.00 | 562.00 |
| 35-39 | 209.00 | 418.00 | 314.00 | 596.00 |
| 40-44 | 259.00 | 518.00 | 389.00 | 622.00 |
| 45-49 | 305.00 | 610.00 | 458.00 | 732.00 |
| 50-54 | 372.00 | 744.00 | 551.00 | 856.00 |
| 55-59 | 439.00 | 878.00 | 593.00 | 966.00 |
| 60-64 | 501.00 | 1002.00 | 652.00 | 1103.00 |
| 65+ | 584.00 | 1168.00 | 748.00 | 1285.00 |
| Age | Deductible : 7500 | |||
| 0-2 | 139.00 | N/A | N/A | N/A |
| 3-18 | 115.00 | N/A | N/A | N/A |
| 19-24 | 135.00 | 270.00 | 203.00 | 378.00 |
| 25-29 | 146.00 | 292.00 | 219.00 | 438.00 |
| 30-34 | 165.00 | 330.00 | 248.00 | 471.00 |
| 35-39 | 173.00 | 346.00 | 260.00 | 494.00 |
| 40-44 | 210.00 | 420.00 | 315.00 | 504.00 |
| 45-49 | 248.00 | 496.00 | 372.00 | 596.00 |
| 50-54 | 303.00 | 606.00 | 449.00 | 697.00 |
| 55-59 | 355.00 | 710.00 | 480.00 | 781.00 |
| 60-64 | 407.00 | 814.00 | 530.00 | 896.00 |
| 65+ | 484.00 | 968.00 | 620.00 | 1065.00 |
Counties : Benton, Clackamas, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill
| Family Status : | Applicant | Applicant and Spouse | Applicant and Child(ren) | Applicant and Family |
| Age | Deductible : 250 | |||
| 0-2 | 241.00 | N/A | N/A | N/A |
| 3-18 | 186.00 | N/A | N/A | N/A |
| 19-24 | 235.00 | 470.00 | 353.00 | 658.00 |
| 25-29 | 254.00 | 508.00 | 381.00 | 762.00 |
| 30-34 | 291.00 | 582.00 | 437.00 | 830.00 |
| 35-39 | 310.00 | 620.00 | 465.00 | 884.00 |
| 40-44 | 399.00 | 798.00 | 599.00 | 958.00 |
| 45-49 | 480.00 | 960.00 | 720.00 | 1152.00 |
| 50-54 | 555.00 | 1110.00 | 822.00 | 1277.00 |
| 55-59 | 673.00 | 1346.00 | 909.00 | 1481.00 |
| 60-64 | 773.00 | 1546.00 | 1005.00 | 1701.00 |
| 65+ | 865.00 | 1730.00 | 1108.00 | 1903.00 |
| Age | Deductible : 500 | |||
| 0-2 | 225.00 | N/A | N/A | N/A |
| 3-18 | 173.00 | N/A | N/A | N/A |
| 19-24 | 219.00 | 438.00 | 329.00 | 614.00 |
| 25-29 | 237.00 | 474.00 | 356.00 | 711.00 |
| 30-34 | 271.00 | 542.00 | 407.00 | 773.00 |
| 35-39 | 289.00 | 578.00 | 434.00 | 824.00 |
| 40-44 | 372.00 | 744.00 | 558.00 | 893.00 |
| 45-49 | 447.00 | 894.00 | 671.00 | 1073.00 |
| 50-54 | 518.00 | 1036.00 | 767.00 | 1192.00 |
| 55-59 | 628.00 | 1256.00 | 848.00 | 1382.00 |
| 60-64 | 721.00 | 1442.00 | 938.00 | 1587.00 |
| 65+ | 807.00 | 1614.00 | 1033.00 | 1776.00 |
| Age | Deductible : 1000 | |||
| 0-2 | 211.00 | N/A | N/A | N/A |
| 3-18 | 162.00 | N/A | N/A | N/A |
| 19-24 | 205.00 | 410.00 | 308.00 | 574.00 |
| 25-29 | 222.00 | 444.00 | 333.00 | 666.00 |
| 30-34 | 254.00 | 508.00 | 381.00 | 724.00 |
| 35-39 | 270.00 | 540.00 | 405.00 | 770.00 |
| 40-44 | 349.00 | 698.00 | 524.00 | 838.00 |
| 45-49 | 419.00 | 838.00 | 629.00 | 1006.00 |
| 50-54 | 485.00 | 970.00 | 718.00 | 1116.00 |
| 55-59 | 587.00 | 1174.00 | 793.00 | 1292.00 |
| 60-64 | 675.00 | 1350.00 | 878.00 | 1485.00 |
| 65+ | 755.00 | 1510.00 | 967.00 | 1661.00 |
| Age | Deductible : 2500 | |||
| 0-2 | 179.00 | N/A | N/A | N/A |
| 3-18 | 138.00 | N/A | N/A | N/A |
| 19-24 | 174.00 | 348.00 | 261.00 | 488.00 |
| 25-29 | 188.00 | 376.00 | 282.00 | 564.00 |
| 30-34 | 215.00 | 430.00 | 323.00 | 613.00 |
| 35-39 | 229.00 | 458.00 | 344.00 | 653.00 |
| 40-44 | 296.00 | 592.00 | 444.00 | 711.00 |
| 45-49 | 355.00 | 710.00 | 533.00 | 852.00 |
| 50-54 | 411.00 | 822.00 | 609.00 | 946.00 |
| 55-59 | 498.00 | 996.00 | 673.00 | 1096.00 |
| 60-64 | 573.00 | 1146.00 | 745.00 | 1261.00 |
| 65+ | 641.00 | 1282.00 | 821.00 | 1411.00 |
| Age | Deductible : 5000 | |||
| 0-2 | 148.00 | N/A | N/A | N/A |
| 3-18 | 114.00 | N/A | N/A | N/A |
| 19-24 | 145.00 | 290.00 | 218.00 | 406.00 |
| 25-29 | 156.00 | 312.00 | 234.00 | 468.00 |
| 30-34 | 179.00 | 358.00 | 269.00 | 511.00 |
| 35-39 | 190.00 | 380.00 | 285.00 | 542.00 |
| 40-44 | 236.00 | 472.00 | 354.00 | 567.00 |
| 45-49 | 277.00 | 554.00 | 416.00 | 665.00 |
| 50-54 | 338.00 | 676.00 | 501.00 | 778.00 |
| 55-59 | 399.00 | 798.00 | 539.00 | 878.00 |
| 60-64 | 456.00 | 912.00 | 593.00 | 1004.00 |
| 65+ | 531.00 | 1062.00 | 680.00 | 1169.00 |
| Age | Deductible : 7500 | |||
| 0-2 | 126.00 | N/A | N/A | N/A |
| 3-18 | 104.00 | N/A | N/A | N/A |
| 19-24 | 123.00 | 246.00 | 185.00 | 345.00 |
| 25-29 | 133.00 | 266.00 | 200.00 | 399.00 |
| 30-34 | 150.00 | 300.00 | 225.00 | 428.00 |
| 35-39 | 158.00 | 316.00 | 237.00 | 451.00 |
| 40-44 | 191.00 | 382.00 | 287.00 | 459.00 |
| 45-49 | 225.00 | 450.00 | 338.00 | 540.00 |
| 50-54 | 276.00 | 552.00 | 409.00 | 635.00 |
| 55-59 | 323.00 | 646.00 | 437.00 | 711.00 |
| 60-64 | 370.00 | 740.00 | 481.00 | 814.00 |
| 65+ | 440.00 | 880.00 | 564.00 | 968.00 |
* - not all of the zip codes are eligible in this county
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