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Oregon Medical Insurance > LifeWise Health Plan of Oregon >

LifeWise Individual and Family Plans

Whether your clients choose the value-packed Essentials plan, the comprehensive Prime plan or the tax-advantaged HSA-Qualified plan they'll get benefits and healthcare coverage that fit their lifestyle.

Preventive exams—we’re here to make staying healthy easier. The following exams are all covered in full.*

  • Routine physicals and physicals for school, sports and employment
  • Women’s or men’s annual exams; well-baby and newborn exams
  • Preventive immunizations

Preventive screenings—these are tests your doctor uses to make sure everything’s going well. The following screenings are covered in full.*

  • Cancer Screenings—Cervical (PAP), prostate (PSA), mammograms and colonoscopies
  • Infectious Disease Screenings—Chlamydia antibody and hepatitis antigen screenings
  • Metabolic, Nutrition and Endocrine Screenings—Glucose testing (blood sugar) and anemia (iron deficiency) screenings
  • Heart and Vascular Disease Screenings—Lipid panel/lipoprotein/high cholesterol screenings and high blood pressure testing
  • Musculoskeletal Disorder Screening—Bone density screening

You’ll also have access to:

Online tools—Access to our secure website that includes tools to help you assess, manage and improve your health. Our secure website offers a health assessment, treatment cost estimator, claims status, your plan benefits, symptom checker and several other useful tools.

Nationwide network coverage—The LifeWise network includes thousands of physicians, specialists and facilities in Oregon so you have a choice when it comes to your medical care. You’re also covered when you travel nationwide by visiting a preferred provider with our partner network, PHCS/MultiPlan.

*In-Network Benefits are illustrated below.

Essentials
Essentials
Prime
HSA-Qualified
HSA-Qualified
LifeWise Health Plans
Effective starting 1/1/2011 		Plan Summary
Plan Rates
Features A good option when you’re looking for a low rate and more up front coverage for routine care needs. This plan provides up front coverage for your first three office visits. A good option when you’re looking for a low rate and more up front coverage for routine care needs. This plan provides up front coverage for your first three office visits. A benefit-rich plan that includes coverage for generic and brand name prescriptions. A nice option if you’re looking to cover all your bases. • Tax-advantaged savings plan
• Lower monthly rates		 • Tax-advantaged savings plan
• Lower monthly rates
Individual Deductible $1,000 / $2,500 / $5,000 $7,500 / $10,000 $1,500 / $2,500 / $5,000 $3,000 individual
$6,000 family** 		$5,950 individual
$11900 family**
Coinsurance
(what you pay) 		35% 40% 30% 25% 0%
Coinsurance Maximum $7,500 $7,500 $6,000 $2,950 Individual $5,900 Family $0
Out-of-Pocket Maximum
 Annual deductible +
coinsurance maximum
 Annual deductible +
coinsurance maximum		 Annual deductible +
coinsurance maximum		 Annual deductible +
coinsurance maximum		 Annual deductible +
coinsurance maximum
Office Visits, Urgent Care & Naturopathy $35 on first 3 visits PCY; additional visits subject to deductible, then 35%. $40 on first 3 visits PCY; additional visits subject to deductible,then 40%. $30 copay on first 4 visits PCY; additional visits subject to deductible, then 30%. Office Visits: Deductible applies first, then you pay 25% Office Visits: Deductible, then covered in full
Preventive Care & Preventive Screenings
(includes mammograms, colonoscopies, PAP & PSA screenings) 		Covered in full Covered in full Covered in full Covered in full Covered in full
Alternative Care
 Deductible waived, $35 copay Deductible waived, $40 copay Deductible waived, $30 copay Deductible, then 25% Deductible, then covered in full
Pharmacy
(Retail 30-day supply) 		$20 copay $20 copay $20 generic; 50% brand ($500 deductible for brand - select drug list) Deductible, then 25% ($5,000 PCY limit) Deductible, then covered in full ($5,000 PCY limit)
Pharmacy
(Mail Order 90-day supply) 		$60 copay $60 copay $60 generic; 50% brand ($500 deductible for brand - select drug list) Deductible, then 25% ($5,000 PCY limit) Deductible, then covered in full ($5,000 PCY limit)
Maternity Prenatal & Postnatal Care: Deductible, then 35% - Routine Delivery: Deductible, then 50% Prenatal & Postnatal Care: Deductible, then 40% - Routine Delivery: Deductible, then 50% Deductible, then 30% Deductible, then 25% Deductible, then covered in full
Vision & Hearing Care—Routine Exam
(1 exam PCY)		 Deductible waived, $35 copay Deductible waived, $35 copay Deductible waived, $30 copay Deductible, then 25% Deductible, then covered in full
* Reimbursable expenses are covered at 100% of maximum allowable amounts; no deductible applies.
** Services for all family members covered under the same HSA-qualified plan are applied to the family deductible. The family deductible must be met before services are covered for any enrolled family members.

 

 
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