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Oregon Medical Insurance > Providence Health Plans > Value Plan Benefits


 
Value Plans
Annual Deductible
Individual/Family
Value 1000 - $1,000/$3,000
Value 2500 - $2,500/$7,500
Value 5000 - $5,000/$15,000
Value 7500 - $7,500/$22,500
Annual Out-of-Pocket Maximum
Individual/ Family
Value 1000 - $6,000/$18,000
Value 2500 - $6,000/$18,000
Value 5000 - $9,000/$27,000
Value 7500 - $11,000/$33,000
Essential Health Benefit Maximum
$1,250,000 plan year aggregate limit
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
Preventive Care
In-Plan
Out-of-Plan
Periodic health exams, well-baby care
Covered in full †
50% †
Routine immunizations/shots
Covered in full †
50% †
Mammograms
Covered in full †
50%
Gynecological exams, Pap tests
Covered in full †
50% †
Physician/Provider Services
Office visits
$30 copay †
50% †
Office visits to specialists
30%
50%
Inpatient hospital visits, surgery and anesthesia
30%
50%
Hospital Services
Inpatient & observation care
30%
50%
Maternity care
30%
50%
Routine newborn nursery care
30%
50%
Rehabilitative care
30%
50%
Emergency/Urgent care
Emergency services
$250 copay
Urgent care visits
$30 copay †
50% †
Emergency transportation
30%
50%
Outpatient Diagnostic Services
X-ray; lab services
30%
50%
Imaging services (PET, CT, MRI)
30%
50%
Other Covered Services
Medical & diabetes supplies
30%
50%
Outpatient surgery, radiation therapy, chemotherapy
30%
50%
Mental health and alcohol treatment
30%
50%
Prescription Drugs
Covered at participating pharmacies at the In-Plan benefit only
Generic drugs & 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.
Routine Vision Services (administerd by VSP)
Routine Vision Exam
(covered once per 12 months)
$30 copay
Covered up to $29
Frames
(covered once per 24 months)
Covered up to $120
Covered up to $33
Basic Lenses (covered once per 24 months)
Single
Covered in full
Covered up to $28
Bifocal
Covered in full
Covered up to $42
Trifocal
Covered in full
Covered up to $56
Contact Lenses
(covered once per 24 months in lieu of complete pair of glassess)
Covered up to $120
Covered up to $65
Extra Discounts and Savings:

Contacts: 15 percent off cost of contact lens exam (fitting and evaluation)

Laser Vision Correction: Average 15 percent off regular price or 5 percent off promotional price from contracted facilities.
Out-of-plan Vision Services: You get the best value from your benefit when you see a VSP doctor. If you see a non-VSP provider, you’ll typically pay more out-of-pocket. You will pay the provider in full and then have 6 months to submit a claim to VSP for partial reimbursement less copays.

 

 

 

 

 
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