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Oregon Medical Insurance > Federal Medical Insurance Pool - FMIP > Plan 500 Benefits


 
FMIP Medical Plan 500
Lifetime Maximum Benefit
$2,000,000
FMIP Pre-existing Waiting Period, including Pregnancy
None
 
In-network you pay
Out-of-network you pay
Annual Medical Deductible
$500
Maximum Annual Medical Out-of-Pocket, excluding medical deductible, per individual 1
$1,500
$3,000
Doctor Visits
20%
40%
Hospital
20%
40%
Outpatient Surgery
20%
40%
Skilled Nursing Care – limited to 60 days
20%
40%
Home Health Care – limited to 130 visits
20%
40%
Emergency Room 2
20% + $200 co-pay
20% + $200 co-pay
Ambulance
20%
Maternity
20%
40%
Diagnostic X-ray/Lab
20%
40%
Transplant 2
0%
40%
Hospice
20%
40%
Rehabilitation Inpatient/Outpatient – limited to 60 days
20%
40%
Durable Medical Equipment
20%
Mental Health/Chemical Dependency
20%
40%
Women's Health Care Services 3
20%
Not covered
Men’s Health Care Services 3
20%
Not covered
Immunizations 3
20%
Not covered
Well-Baby Care/Well-Child Care 3
20%
Not covered
Preventive Care under the PPACA3
0%
Not Covered
Prescription Drugs: Deductibles and out-of-pocket maximum on prescription drugs 2
$0 Rx deductible
$3.950 out-of-pocket max.
Generic Coinsurance 4
Up to $5
Preferred Brand Coinsurance 4
Up to $40
Non-Preferred Brand Coinsurance
Up to $70
  1. This is the maximum amount you will pay for covered medical services per individual, per calendar year, excluding the deductibles, before FMIP will begin paying 100% for covered services.
  2. The emergency room co-pay, out-of-pocket prescription drug payments, transplants ($250,000 max. per transplant on FMIP plans) performed at noncontracting facilities, and disallowed charges do not apply to the medical deductible or out-of-pocket maximum.
  3. These services do NOT accumulate towards the maximum annual out-of-pocket expense. Also, you do not have to meet the annual medical deductible before FMIP pays for these services. Coverage is provided only for those preventative care services designated by: The United States Preventive Services Task Force (USPSTF) for services with an A or B rating in the current recommendations; by the Health Resources and Services Administration (HRSA); or by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC).
  4. $0 co-payment for fluoride, regular aspirin, and iron as specified by the Patient Protection Affordable Care Act and specific diabetic supplies, insulin (excluding pumps), and evidence-based generic maintenance medications as determined by OMIP. A list of these medications can be found on our website at www.omip.state.or.us. This list is subject to change.

This list is subject to change. This Health Benefit Plan Summary is intended only as a brief summary of our benefit plans. Please refer to the contract for specific details. Exact terms, conditions, provisions, exclusions, and limitations are defined in the contract.

 

 

 
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