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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 > Prime Plan Benefits
Providence Health Plans of Oregon
| General Benefits | ||
|---|---|---|
| Annual Deductible Individual/Family |
$10,000/$30,000 | |
| Annual Out-of-Pocket Maximum Individual/Family |
$12,500/$37,500 | |
| Accidental Injury Benefit | The deductible is waived for all covered services, except for chiropractic services, required to treat an accidental injury within 90 days of injury. | |
| 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 †. *Limitations apply. See your Plan Contract for details |
||
| In-Plan | Out-of-Plan | |
| Preventive Care | ||
| Periodic health exams, well-baby care | Covered in full † | Not Covered |
| Routine immunizations/shots | Covered in full † | Not Covered |
| Mammograms | Covered in full † | Not Covered |
| Gynecological exams, Pap tests | Covered in full † | Not Covered |
| Physician/Provider Services | ||
| Office visits to a personal physician/provider | 50% † | Not Covered |
| Office visits to specialists | 50% † | Not Covered |
| Inpatient hospital visits, surgery and anesthesia | 50% | Not Covered |
| Hospital Services | ||
| Inpatient & observation care | 50% | Not Covered |
| Maternity care | 50% | Not Covered |
| Routine newborn nursery care | 50% | Not Covered |
| Rehabilitative care | 50% | Not Covered |
| Emergency/Urgent care | ||
| Emergency services | 50% | Not Covered |
| Urgent care visits | 50% | Not Covered |
| Emergency transportation |
50% | Not Covered |
| Outpatient Diagnostic Services | ||
| X-ray; lab services | 50% | Not Covered |
| Imaging services (PET, CT, MRI) | 50% | Not Covered |
| Other Covered Services | ||
| Medical & diabetes supplies | 50% | Not Covered |
| Outpatient surgery, radiation therapy, chemotherapy | 50% | Not Covered |
| Mental health and alcohol treatment | 50% | Not Covered |
| Prescription Drugs | ||
| Covered at participating retail and mail-order pharmacies only | Generic drugs - $20 † Brand-name drugs - 50% † |
|
| Alternative care services | ||
| Acupuncture, chiropractic care, massage therapy and dietitian services | Receive 25% off provider rates through the Choose Healthy network. | |