2015 LifeWise Oregon Health Plans

LifeWise is a local company that provides individual and family health coverage to Oregonians who want to get and stay as healthy as they can. They trust us to be their health plan because of our history: For 29 years, we’ve been actively supporting and encouraging Oregonians to live the healthiest lives possible through our coverage, programs, and services.

Your LifeWise network offers a choice of doctors, hospitals, and pharmacies around the state that offer great care at great values. LifeWise has an established record of providing easyto- use services with support for you from our Customer Service team.

Part of the LifeWise value to you is that for a number of important benefits, deductible is waived. That is, you don’t have to spend $2,000 out of your pocket, for example, before the plan begins to pay its share of costs.

For silver and gold plans, deductible is waived for:

  • Basic diagnostic imaging, such as X-rays and CT scans, and covered lab work
  • Generic prescriptions
  • Office visits with in-network providers
  • Covered preventive care

You can choose a plan from three metallic levels – bronze, silver or gold. Monthly health plan costs vary by:

  • Metallic level
  • Number of people on the plan
  • Ages of people covered
  • Tobacco usage
  • Location

All plans have the same benefits. The amount you pay for your medical care will vary depending on the plan you choose.

10 Essential Benefits

Healthcare reform says all health plans must include ten essential benefits. The basic benefits include:

  1. Outpatient Care - the kind you get without being admitted to a hospital
  2. Emergency Services - for issues that could lead to death or disable you if you do not treat them.
  3. Inpatient Care - covers room and board, tests, drugs, and care from doctors and nurses while admitted, which may include organ and tissue transplants, and hospice and respite care.
  4. Maternity and Newborn Care - care before and after your baby is born
  5. Mental Health and Substance Use Disorder Services - this includes behavioral health treatment, counseling, and psychotherapy.
  6. Prescription Drugs - covers retail, mail order, and specialty drugs.
  7. Rehabilitative and Habilitative Services - services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8. Laboratory Services - covers lab tests, X-ray services, and pathology, and imaging and diagnostics such as MRI, CT scan, and PET scan.
  9. Preventive and Wellness Services - including mammograms, colonoscopies, vaccines. Covered in full if you use in-network providers for care such as routine physicals, screening, and immunizations. Disease management coordinates care for diabetes, asthma, and other conditions.
  10. Pediatric Services - including dental care (preventive, basic, major) and vision care (eye exam, lenses, and eyewear).

PPO vs EPO plans

Preferred provider organization (PPO) and exclusive provider organization (EPO) plans use the LifeWise Oregon provider network.

Monthly premiums for EPO plans are generally lower than comparable PPO plan premiums.

With a PPO plan, you may use out-ofnetwork providers for covered services. If you see an out-of-network provider, you pay a higher share of the costs.

The EPO plan covers services from healthcare providers in the LifeWise Oregon network. An EPO plan also covers emergency care received from any healthcare provider, including those not in our network. If you receive non-emergency care from a healthcare provider who is not in the LifeWise Oregon network, which includes any provider outside Oregon state, you will be responsible for the full cost of that care. To see which doctors and hospitals are in this network, use the Find a Doctor tool.