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Index | Exclusions | Provider Directory | Application
Plan Benefits:
Optimum Benefits | Value Benefits | Prime Benefits | HSA Benefits
Plan Rates:
Optimum Rates | Value Rates | Prime Rates | HSA Rates
Oregon Health Insurance Plans
LifeWise Health Plans of Oregon
Regence BC BS of OR
Moda Health
PacificSource
Providence Health Plans
HealthNet of Oregon
Kaiser Permanente
Oregon Medical Insurance Pool
Medicare Supplement Plans
- Medicare 101
- Medicare Plans Overview
- Medicare Information Request
- Medicare Supplements
- Medicare Part D
- Aetna
- Columbian Mutual
- Gerber Life
- HealthNet
- Humana
- Lifewise
- Medico Insurance Company
- ODS Senior Select
- Regence
- Sentinel Life
- Sterling
- Stonebridge Life
- United of Omaha
- UCT
- UnitedHealthcare
- Woodmen
Medicare Advantage Plans
- Medicare Advantage Overview
- Medicare Information Request
- Atrio Health Plans
- HealthNet
- ODS
- ODS Legacy Health
- ODS Salem Health
- PacificSource
- Providence
- Regence
- Trillium
- UnitedHealthcare
Other Insurance
Oregon Medical Insurance > Providence Health Plans > HSA Plan Benefits
Providence Health Plans of Oregon
| HSA 2500 | HSA 3500 | |||
|---|---|---|---|---|
| Annual Deductible Individual/Family |
$2,500/$5,000 | $3,500/$7,000 | ||
| Annual Out-of-Pocket Maximum Individual/Family |
$5,000/$10,000 | $5,950/$11,900 | ||
| Essential Health Benefit Maximum | $1,250,000 plan year aggregate limit | $1,250,000 plan year aggregate limit | ||
| Accidental Injury Benefit | Does not apply | Does not apply | ||
| After meeting your deductible, you pay the following amounts for covered services: The deductible is waived for some covered services. These services are marked with †. |
||||
| In-Plan | Out-of-Plan | In-Plan | Out-of-Plan | |
| Preventive Care | ||||
| Periodic health exams, well-baby care | Covered in full † | 40% | Covered in full † | 50% |
| Routine immunizations/shots | Covered in full † | 40% | Covered in full † | 50% |
| Mammograms | Covered in full † | 40% | Covered in full † | 50% |
| Gynecological exams, Pap tests | Covered in full † | 40% | Covered in full † | 50% |
| Physician/Provider Services | ||||
| Office visits | $20 copay | 40% | 50% | 50% |
| Office visits to specialists | 20% | 40% | 50% | 50% |
| Inpatient hospital visits, surgery, anesthesia | 20% | 40% | 50% | 50% |
| Hospital Services | ||||
| Inpatient and observation care | 20% | 40% | 50% | 50% |
| Maternity care | 20% | 40% | 50% | 50% |
| Routine newborn nursery care | 20% | 40% | 50% | 50% |
| Rehabilitative care | 20% | 40% | 50% | 50% |
| Emergency/Urgent care | ||||
| Emergency services | $250 copay | 50% | 50% | |
| Urgent care services | $20 copay | 40% | 50% | 50% |
| Emergency transportation | 20% | 20% | 50% | 50% |
| Outpatient Diagnostic Services | ||||
| X-ray; lab services | 20% | 40% | 50% | 50% |
| Imaging services (PET, CT, MRI) | 20% | 40% | 50% | 50% |
| Other Covered Services | ||||
| Medical & Diabetes Supplies | 20% | 40% | 50% | 50% |
| Outpatient surgery, radiation therapy, chemotherapy | 20% | 40% | 50% | 50% |
Mental health & alcohol treatment |
20% | 40% | 50% | 50% |
| Prescription Drugs | ||||
| Covered at participating retail and mail-order pharmacies only | Generic and brand-name drugs (up to a 30-day supply) - 50% | |||
| Alternative care services | ||||
| Acupuncture, chiropractic care, massage therapy and dietitian services | Receive 25% off provider rates through the Choose Healthy network. | |||