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Oregon Health Insurance
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Providence Value Plan

Effective Date: 11/01/2012
Expiration Date: 10/31/2013

Available in: 97324, 97330, 97331, 97333, 97339, 97370, 97456, 97004, 97009, 97011, 97013, 97015, 97017, 97022, 97023, 97027, 97028, 97034, 97035, 97036, 97038, 97042, 97045, 97049, 97055, 97067, 97068, 97070, 97086, 97089, 97222, 97267, 97268, 97269, 97102, 97103, 97110, 97121, 97138, 97145, 97146, 97016, 97018, 97048, 97051, 97053, 97054, 97056, 97064, 97751, 97752, 97753, 97754, 97701, 97702, 97707, 97708, 97709, 97712, 97739, 97756, 97759, 97410, 97416, 97417, 97429, 97432, 97435, 97436, 97441, 97442, 97443, 97447, 97457, 97462, 97467, 97469, 97470, 97471, 97473, 97479, 97481, 97484, 97486, 97494, 97495, 97496, 97499, 97812, 97823, 97861, 97817, 97820, 97825, 97845, 97848, 97856, 97864, 97865, 97869, 97873, 97710, 97720, 97721, 97722, 97732, 97736, 97738, 97758, 97904, 97031, 97041, 97044, 97501, 97502, 97503, 97504, 97520, 97522, 97524, 97525, 97530, 97535, 97536, 97537, 97539, 97540, 97541, 97711, 97730, 97734, 97741, 97760, 97761, 97497, 97523, 97526, 97527, 97528, 97531, 97532, 97533, 97534, 97538, 97543, 97544, 97321, 97322, 97327, 97329, 97335, 97336, 97345, 97348, 97355, 97358, 97360, 97374, 97377, 97386, 97389, 97446, 97002, 97020, 97026, 97032, 97071, 97137, 97301, 97302, 97303, 97305, 97306, 97307, 97308, 97309, 97310, 97311, 97312, 97314, 97317, 97325, 97342, 97346, 97350, 97352, 97362, 97373, 97375, 97381, 97383, 97384, 97385, 97392, 97010, 97014, 97019, 97024, 97030, 97060, 97080, 97201, 97202, 97203, 97204, 97205, 97206, 97207, 97208, 97209, 97210, 97211, 97212, 97213, 97214, 97215, 97216, 97217, 97218, 97219, 97220, 97221, 97227, 97228, 97230, 97231, 97232, 97233, 97236, 97238, 97239, 97240, 97242, 97256, 97258, 97266, 97280, 97282, 97283, 97286, 97290, 97292, 97293, 97294, 97296, 97304, 97338, 97344, 97347, 97351, 97361, 97371, 97029, 97033, 97039, 97050, 97065, 97107, 97108, 97112, 97118, 97122, 97130, 97131, 97134, 97135, 97136, 97141, 97143, 97147, 97149, 97001, 97021, 97037, 97040, 97057, 97058, 97063, 97005, 97006, 97007, 97008, 97062, 97075, 97076, 97077, 97106, 97109, 97113, 97116, 97117, 97119, 97123, 97124, 97125, 97133, 97140, 97144, 97223, 97224, 97225, 97229, 97281, 97291, 97298, 97750, 97830, 97874, 97101, 97111, 97114, 97115, 97127, 97128, 97132, 97148, 97378, 97396, 97401, 97402, 97403, 97404, 97405, 97408, 97409, 97412, 97413, 97419, 97424, 97426, 97431, 97434, 97437, 97438, 97440, 97451, 97452, 97454, 97455, 97461, 97463, 97477, 97478, 97487, 97488, 97489, 97490, 97492, 97733, 97737, 97427, 97482, 97472, 97425
Deductible: $1,000
Age Applicant Alone Applicant and Spouse Applicant and Child Applicant and Family
1-17 $127.00
18-20 $165.00 $329.00 $247.00 $462.00
21-24 $196.00 $395.00 $297.00 $552.00
25-29 $213.00 $426.00 $320.00 $629.00
30-34 $242.00 $486.00 $363.00 $726.00
35-39 $260.00 $519.00 $388.00 $764.00
40-44 $330.00 $661.00 $496.00 $959.00
45-49 $390.00 $781.00 $585.00 $975.00
50-54 $453.00 $906.00 $680.00 $1,042.00
55-59 $545.00 $1,090.00 $819.00 $1,253.00
60-64 $625.00 $1,251.00 $938.00 $1,375.00
 
Deductible: $2,500
Age Applicant Alone Applicant and Spouse Applicant and Child Applicant and Family
1-17 $110.00
18-20 $141.00 $282.00 $211.00 $395.00
21-24 $169.00 $338.00 $254.00 $474.00
25-29 $182.00 $365.00 $274.00 $538.00
30-34 $207.00 $414.00 $311.00 $623.00
35-39 $222.00 $445.00 $333.00 $655.00
40-44 $283.00 $566.00 $424.00 $821.00
45-49 $333.00 $668.00 $502.00 $834.00
50-54 $387.00 $777.00 $582.00 $891.00
55-59 $467.00 $932.00 $699.00 $1,073.00
60-64 $534.00 $1,070.00 $804.00 $1,177.00
 
Deductible: $5,000
Age Applicant Alone Applicant and Spouse Applicant and Child Applicant and Family
1-17 $92.00
18-20 $120.00 $238.00 $179.00 $335.00
21-24 $144.00 $286.00 $215.00 $401.00
25-29 $154.00 $309.00 $231.00 $456.00
30-34 $176.00 $351.00 $264.00 $526.00
35-39 $188.00 $375.00 $282.00 $553.00
40-44 $239.00 $480.00 $360.00 $694.00
45-49 $282.00 $565.00 $423.00 $705.00
50-54 $328.00 $657.00 $492.00 $754.00
55-59 $395.00 $789.00 $592.00 $907.00
60-64 $453.00 $905.00 $678.00 $996.00
 
Deductible: $7,500
Age Applicant Alone Applicant and Spouse Applicant and Child Applicant and Family
1-17 $78.00
18-20 $102.00 $202.00 $152.00 $284.00
21-24 $122.00 $242.00 $183.00 $339.00
25-29 $131.00 $263.00 $197.00 $387.00
30-34 $149.00 $298.00 $223.00 $447.00
35-39 $159.00 $319.00 $238.00 $471.00
40-44 $204.00 $406.00 $306.00 $589.00
45-49 $239.00 $480.00 $361.00 $600.00
50-54 $279.00 $557.00 $418.00 $641.00
55-59 $335.00 $671.00 $503.00 $771.00
60-64 $384.00 $769.00 $576.00 $847.00
 
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