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Index | Exclusions
& Limitations | Locate
Providers | Application
Plan Benefits:
Elect Premiere | Elect Preferred
| Elect FlexPerks | Elect Value
Plan Rates:
Elect Premiere | Elect Preferred | Elect FlexPerks | Elect Value
LifeWise Health Plans of Oregon
Regence BC BS of OR
ODS Health Plans
PacificSource
Providence Health Plans
HealthNet of Oregon
Kaiser Permanente
Oregon Medical Insurance Pool
Medicare Supplement Plans
- Medicare Plans Overview
- Medicare Supplements
- Medicare Advantage
- Medicare Part D
- AARP
- American Republic
- Humana
- Lifewise
- ODS Senior Select
- Regence
- United of Omaha
- UCT
- Woodmen
Other Insurance
Oregon Medical Insurance > PacificSource Health Plans > Elect FlexPerks Benefits
Elect HSA (HSA-Qualified) |
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| Maximum Lifetime Benefit | $2 million |
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| Annual Deductible | Out-of-Pocket Limit(individual / family) | |||
| Participating Provider Annual Deductible &
Out-of-Pocket (OOP) Limit (Copayments and deductible apply to out-of-pocket limit) |
$1,500 per person / $3,000 per family |
$5,000/$10,000 |
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$2,000 per person / $4,000 per family |
$5,000/$10,000 |
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$3,000 per person / $6,000 per family |
$5,800/$11,600 |
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$5,000 per person / $10,000 per family |
$5,000/$10,000 |
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| Out-of-Pocket Limit, Nonparticipating Provider (Minus the amount of the plan’s deductible) |
$10,000 per person |
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| Accident Benefit (accident-related covered expenses) |
The first $1,000 of covered expense within 90 days of an accident is paid at 100% and is not subject to the deductible. The balance is covered
as shown below. |
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Deductible Option: |
$1,500, $2,000 or $3,000 |
$5,000 |
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Provider Type: |
Participating |
Nonpar ‡ |
Participating |
Nonpar ‡ |
| Preventive Care | ||||
Well Baby Care |
70% + |
50% + |
100% |
50% |
Routine Physicals and Preventive Care Exams |
70% + † |
50% + † |
100% † |
50% † |
Routine Gynecological Exams |
70% + |
50% + |
100% |
50% |
Immunizations |
70% + |
50% + |
100% |
50% |
| Professional Services | ||||
| Office and Home Visits | 70% |
50% |
100% |
50% |
Surgery |
70% |
50% |
100% |
50% |
| Chiropractic Manipulation | Not Covered |
Not Covered |
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Acupuncture |
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Naturopathic Care |
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Urgent Care Center Visits |
70% |
50% |
100% |
50% |
| Maternity Care | ||||
| Practitioner Services & Hospital Stay | 70% |
50% |
100% |
50% |
| Hospital Services | ||||
Inpatient Room and Board |
70% |
50% |
100% |
50% |
Inpatient Rehabilitative Care |
70% |
50% |
100% |
50% |
Skilled Nursing Facility Care |
70% |
50% |
100% |
50% |
| Outpatient Services | ||||
Outpatient Hospital/Facility |
70% |
50% |
100% |
50% |
Diagnostic & Therapeutic Radiology and Lab |
70% |
50% |
100% |
50% |
CT/PET Scans, Cath Labs, and MRIs |
70% |
50% |
100% |
50% |
Emergency Room Visits* |
70% |
50% |
100% |
50% |
| Other Covered Services | ||||
Prescription Drugs (no annual max) |
70% |
Not covered |
100% |
Not covered |
Physical Therapy |
70% |
50% |
100% |
50% |
Allergy Injections |
70% |
50% |
100% |
50% |
Ambulance Service |
70% |
50% |
100% |
50% |
Durable Medical Equipment/Prosthesis |
70% |
50% |
100% |
50% |
Home Health, Hospice, and Respite Care |
70% |
50% |
100% |
50% |
Inpatient Mental Health Services |
70% |
50% |
100% |
50% |
| Transplant Services | 70% |
Lesser of 50% of billed amount or $100,000 |
100% |
Lesser of 50% of billed amount or $100,000 |
| Note: + = Not subject to the annual deductible. † = Scheduled benefit ‡ = Payment to providers is based on the PacificSource fee allowance. While participating providers accept the fee allowance as payment in full, nonparticipating providers may not. Services of nonparticipating providers could result in out-of-pocket expense in addition to the percentage indicated. |
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