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Index | Qualifying Conditions | Exclusions
& Limitations | Locate
Providers | Application
Plan Benefits:
Plan 500 | Plan 750
| Plan 1000 | Plan 1500
Plan Rates:
Plan 500 | Plan 750 | Plan 1000 | Plan 1500
Oregon Medical Insurance > Oregon Medical Insurance Pool - OMIP > Plan 1500 Benefits
|
Medical & Portability Plan 1500 Benefit Summary |
||
| Lifetime Maximum Benefit |
$2,000,000 |
|
| Pre-existing Waiting Period, Including Pregnancy |
6 months |
|
|
In Network you pay |
Out of Network you pay |
|
| Annual Prescription Deductible | $1,000 |
|
| Annual Medical Deductible |
$1,500 |
|
| Maximum Annual Medical Out of Pocket, excluding medical deductible, per individual* |
$6,000 |
$12,000 |
| Doctor Visits |
30% |
50% |
| Hospital |
30% |
50% |
| Outpatient Surgery |
30% |
50% |
| Skilled Nursing Care - limited to 60 days |
30% |
|
| Home Health Care - limited to 60 visits |
30% |
50% |
| Emergency Room** |
30% + $100 copay |
30% + $100 copay |
| Ambulance |
30% |
|
| Maternity |
30% |
50% |
| Diagnostic X-Ray/Lab |
30% |
50% |
| Transplant** |
0% |
50% |
| Hospice |
30% |
50% |
| Rehabilitation Inpatient - limited to 60 days |
30% |
50% |
| Rehabilitation Outpatient - limited to 60 days |
30% |
50% |
| Durable Medical Equipment |
30% |
|
| Mental Health |
30% |
50% |
| Chemical Dependency |
30% |
50% |
| Womens Health Care Services*** |
20% |
Not Covered |
| Mens Health Care Services*** |
20% |
Not Covered |
| Immunizations - for enrolled child(ren) through age 18*** |
20% |
Not Covered |
| Well Baby Care*** |
20% |
Not Covered |
| Well Child Care*** |
20% |
Not Covered |
| Prescription Drugs: Annual $1,000 Rx Deductible & no out of pocket maximum on prescription drugs** | ||
| Generic Co-Insurance |
up to $10 - Cost over $10 - $10 |
|
| Preferred Brand Co-Insurance |
up to $40 - Cost over $40 - $40 |
|
| Non-Prefered Brand Co-Insurance |
up to $60 - Cost over $60 - $60 |
|
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* This is the maximum amount you will pay for covered
services per individual, per calendar year before OMIP will begin paying
100% for covered services.
** The Emergency Room copay, out of pocket prescription drug payments, transplants performed at non-contracting facilities, and disallowed charges do not apply to the medical deductible or out of pocket maximum. *** 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 OMIP pays for these services. |
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