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Oregon Medical Insurance > Regence BlueCross BlueShield of Oregon > Blue Selections Basic Benefits

Providence Health Plans
BlueSelections Basic
Lifetime benefit maximum
$2 million per individual
Deductibles
  • $1,000 per person
  • $2,500 per person
  • $5,000 per person
  • $10,000 per person
  • $3,000 family
  • $7,500 family
  • $15,000 family
  • $30,000 family
Annual Maximum Coinsurance
(maximum of three coinsurance maximums per contract)
In-Network:
$10,000
Out-Of-Network:
$10,000
Preventative Care Services
Adult and Child Immunizations
50%, not subject to deductible
50%, not subject to deductible
Annual Women's Exams includes PAP smear and mammogram
50%, not subject to deductible
50%, not subject to deductible
Annual Men's Exams includes PSA test
50%, not subject to deductible
50%, not subject to deductible
Well-baby exam to age 2
50%, not subject to deductible
50%, not subject to deductible
Well Child
50%, not subject to deductible
50%, not subject to deductible
 
Dental Services
Individual Dentacare (optional)
Office Visit
Physician services
In-Network:
We pay 50%
Out-Of-Network:
We pay 50%
Hospitalizations
Hospital Facility
(Inpatient & Outpatient)
In-Network:
We pay 50%
Out-Of-Network:
We pay 50%
Emergency Room
We pay 50% after $100 copay
Laboratory and Radiology Services
In-Network:
We pay 50%
Out-Of-Network:
We pay 50%
Maternity
In-Network:
We pay 50%
Out-Of-Network:
We pay 50%
Vision
Eye Exam (Refractions)
Not covered
Hardware (Glasses, Lenses, Contacts)
Not covered
Prescription Drugs
Generic: We pay 100% after $10 copay
We pay 50% for all other charges,
$2,000 annual limit
Regence Rx discount available after limit is reached.
Additional Benefits
Accidental death Provide $10,000 for you and your enrolled adult spouse, $2,000 for each enrolled dependent or child subscriber
 

 
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