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Oregon Medical Insurance
Pool (OMIP)
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Benefits: OMIP Plan
750 | OMIP Plan 1000 | OMIP Plan 1500 | FMIP Plan 500 | FMIP Plan 750
Rates: OMIP Plan
750 | OMIP Plan 1000 | OMIP Plan
1500 | FMIP Plan 500 | FMIP Plan 750
Federal Medical Insurance Pool (FMIP)
| |
FMIP Medical Plan 500 |
| Lifetime Maximum Benefit |
$2,000,000 |
| FMIP Pre-existing Waiting Period, including Pregnancy |
None |
| |
In-network you pay |
Out-of-network you pay |
| Annual Medical Deductible |
$500 |
| Maximum Annual Medical Out-of-Pocket, excluding medical deductible, per individual 1 |
$1,500 |
$3,000 |
| Doctor Visits |
20% |
40% |
| Hospital |
20% |
40% |
| Outpatient Surgery |
20% |
40% |
| Skilled Nursing Care – limited to 60 days |
20% |
40% |
| Home Health Care – limited to 130 visits |
20% |
40% |
| Emergency Room 2 |
20% + $200 co-pay |
20% + $200 co-pay |
| Ambulance |
20% |
| Maternity |
20% |
40% |
| Diagnostic X-ray/Lab |
20% |
40% |
| Transplant 2 |
0% |
40% |
| Hospice |
20% |
40% |
| Rehabilitation Inpatient/Outpatient – limited to 60 days |
20% |
40% |
| Durable Medical Equipment |
20% |
| Mental Health/Chemical Dependency |
20% |
40% |
| Women's Health Care Services 3 |
20% |
Not covered |
| Men’s Health Care Services 3 |
20% |
Not covered |
| Immunizations 3 |
20% |
Not covered |
| Well-Baby Care/Well-Child Care 3 |
20% |
Not covered |
| Preventive Care under the PPACA3 |
0% |
Not Covered |
| Prescription Drugs: Deductibles and out-of-pocket maximum on prescription drugs 2 |
$0 Rx deductible |
$3.950 out-of-pocket max. |
| Generic Coinsurance 4 |
Up to $5 |
| Preferred Brand Coinsurance 4 |
Up to $40 |
| Non-Preferred Brand Coinsurance |
Up to $70 |
- This is the maximum amount you will pay for covered medical services per individual, per calendar year, excluding the deductibles, before FMIP will begin paying 100% for covered services.
- The
emergency room co-pay, out-of-pocket prescription drug payments, transplants ($250,000 max. per transplant on FMIP plans) performed at noncontracting 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 FMIP pays for these services. Coverage is provided only for those preventative care services designated by: The United States Preventive Services Task Force (USPSTF) for services
with an A or B rating in the current recommendations; by the Health Resources and Services Administration (HRSA); or by the Advisory Committee on Immunization Practices of the Centers for Disease
Control and Prevention (CDC).
- $0 co-payment for fluoride, regular aspirin, and iron as specified by the Patient Protection Affordable Care Act and specific diabetic supplies, insulin (excluding
pumps), and evidence-based generic maintenance medications as determined by OMIP. A list of these medications can be found on our website at www.omip.state.or.us. This list is subject to change.
This list is subject to change. This Health Benefit Plan Summary is intended only as a brief summary of
our benefit plans. Please refer to the contract for specific details. Exact terms, conditions, provisions, exclusions, and limitations are defined in the contract. |
But please remember to read through the OMIP packet carefully before making a decision.
This information is taken from the Oregon Department of Consumer and Business Services web site. Every reasonable effort is made to assure the accuracy of the information provided
here. CDA Insurance LLC is a licensed and independent agency that can assist consumers in securing this coverage. |
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