Providence Health Plans for Oregon

Oregon Health Insurance
Call 800.884.2343 or
541.434.9613
FAX - 541.284.2994

Oregon Medical Insurance > Providence Health Plans > Prime Plan Benefits

	Prime Plan
Annual Deductible Individual/Family	$10,000/$30,000
Annual Out-of-Pocket Maximum Individual/Family	$10,000/$30,000
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 †	Not Covered
Routine immunizations/shots	Covered in full †	Not Covered
Mammograms	Covered in full †	Not Covered
Gynecological exams, Pap tests	Covered in full †	Not Covered
Physician/Provider Services
Office visits to a personal physician/provider	50% †	Not Covered
Office visits to specialists	50% †	Not Covered
Inpatient hospital visits, surgery and anesthesia	50%	Not Covered
Hospital Services
Inpatient & observation care	50%	Not Covered
Maternity care	50%	Not Covered
Routine newborn nursery care	50%	Not Covered
Rehabilitative care	50%	Not Covered
Emergency/Urgent care
Emergency services	50%	Not Covered
Urgent care visits	50%	Not Covered
Emergency transportation	50%	Not Covered
Outpatient Diagnostic Services
X-ray; lab services	50%	Not Covered
Imaging services (PET, CT, MRI)	50%	Not Covered
Other Covered Services
Medical & diabetes supplies	50%	Not Covered
Outpatient surgery, radiation therapy, chemotherapy	50%	Not Covered
Mental health and alcohol treatment	50%	Not Covered
Prescription Drugs
Covered at participating retail and mail-order pharmacies only	Generic drugs - $20 † 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.

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Oregon Medical Insurance > Providence Health Plans > Prime Plan Benefits