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Oregon Medical Insurance > HealthNet of Oregon > Crystal HDHP 100% Benefits

HealthNet Health Plans

 
Crystal HDHP 100% Plans
In-Network
Out of Network
Deductible Choices
The deductible Coverage Year (CY) is January 1 through December 31
Individual: $2,000, or $5,000 (1)
Individual: $4,000, or $10,000 (1)
Family: $4,000, or $10,000 (1)
Family: $8,000, or $20,000 (1)
Lifetime maximum
$2,000,000 combined
Out-of-pocket maximum (OPM)

Individual

Same as deductible (2)
2 x deductible (2)

Family

Same as deductible (2)
2 x deductible (2)
Professional Services
Office visit
No charge
50% UCR+
Well Baby Care (8 exams in the first 24 months) (6)
No charge
50% UCR+
Annual OB/GYN exam
(breast and pelvic exams, cervical cancer screening & mammography) (6)
No charge
50% UCR+
X-ray and laboratory procedures
No charge
50% UCR+
Outpatient Services
Outpatient or ambulatory care center
No charge
50% UCR+
Outpatient rehabilitation therapy
($2,500/year max)
No charge
50% UCR+
Outpatient facility services
(other than surgery)
No charge
50% UCR+
Maternity care
Physicians services for maternity care
No charge
50% UCR+
Hospitalization services
Inpatient hospital care
No charge
50% UCR+
Skilled nursing facility care
(60 days per year max)
No charge
50% UCR+
Inpatient rehabilitation therapy
(30 days per year max)
No charge
50% UCR+
Emergency health coverage
Outpatient emergency room services
No charge
50% UCR+
Inpatient admission from emergency room
No charge
50% UCR+
Emergency ambulance
(up to $3,000 per year)
No charge
No charge UCR+
Additional Accident
Accidental injury deductible waiver **
Not included
Prescription Benefit***
Subject to medical deductible
In Pharmacy
(Per Fill Up to a 30-day Supply)
Mail Order
(Per Fill Up to a 90-day Supply)

Tier 1 drug list
No charge
No charge

Tier 2 drug list
No charge
No charge

Tier 3 & Specialty
You pay 100%***
Preventive benefits
Routine physical, prostate screening, vision screening
Included

Notes:

(1) The deductible must be met each calendar year (January 1 through December 31) before Health Net pays any claims. With this plan, the deductible applies to the annual out-of-pocket maximum. Family coverage means the subscriber and spouse; the subscriber and child(ren); or the subscriber, spouse and child(ren). Under family coverage, each member’s covered expenses count toward the deductible, but the specified family coverage deductible must be met before Health Net pays any claims.
(2) The annual out-of-pocket maximum (OPM) is included the annual deductible.
(6) The CY deductible is waived

PRESCRIPTION DRUG PROGRAM

*** In Pharmacy: Prescription drugs may be filled at a participating pharmacy (up to a 30-day supply). Mail Order: Prescription drugs may be filled through our participating mail pharmacy (up to a 90-day supply). When Tier 3 brand name drugs are not covered, members will still have the advantage of Health Net's pharmacy discounts..

Refer to your contract for details, limitations and exclusions.

 
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