| |
Medical Plan 1000 Benefit Summary |
| Lifetime Maximum Benefit |
$2,000,000 |
| Pre-existing Waiting Period, Including Pregnancy |
6 months |
| |
In Network you pay |
Out of Network you pay |
| Annual Prescription Deductible |
$0 |
| Annual Medical Deductible |
$1,000 |
| Maximum Annual Medical Out of Pocket, excluding medical
deductible, per individual* |
$4,000 |
$8,000 |
| Doctor Visits |
20% |
40% |
| Hospital |
20% |
40% |
| Outpatient Surgery |
20% |
40% |
| Skilled Nursing Care - limited to 60 days |
20% |
| Home Health Care - limited to 60 visits |
20% |
40% |
| Emergency Room** |
20% + $100 copay |
20% + $100 copay |
| Ambulance |
20% |
| Maternity |
20% |
40% |
| Diagnostic X-Ray/Lab |
20% |
40% |
| Transplant** |
0% |
40% |
| Hospice |
20% |
40% |
| Rehabilitation Inpatient - limited to 60 days |
20% |
40% |
| Rehabilitation Outpatient - limited to 60 days |
20% |
40% |
| Durable Medical Equipment |
20% |
| Mental Health |
20% |
40% |
| Chemical Dependency |
20% |
40% |
| Womens Health Care Services*** |
20% |
Not Covered |
| Mens Health Care Services*** |
20% |
Not Covered |
| Immunizations - for enrolled child(ren) through age 18*** |
20% |
Not Covered |
| Well Baby Care*** |
20% |
Not Covered |
| Well Child Care*** |
20% |
Not Covered |
| Prescription Drugs: No out of pocket maximum on prescription drugs** & $0 Rx deductible |
| Generic Co-Insurance |
up to $10 - Cost
over $10 - $10 |
| Preferred Brand Co-Insurance |
up to $40 - Cost
over $40 - $40 |
| Non-Prefered Brand Co-Insurance |
up to $70 - Cost
over $70 - $70 |
|
* This is the maximum amount you will pay for covered
services per individual, per calendar year before OMIP will begin paying
100% for covered services.
** The Emergency Room copay, out of pocket prescription drug payments,
transplants performed at non-contracting 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 OMIP pays for these services.
This Health Benefit Plan Summary is only intended as a brief summary
of our benefit plans. Please refer to the OMIP contract for specific
details. Exact terms, conditions, provisions, exclusions
and limitations are defined in the OMIP 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. InsuranceQuest, LLC is a licensed
and independent agency that can assist consumers in
securing this coverage.
Plan Updates 
