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Oregon Medical Insurance
Pool (OMIP)
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Conditions | Provider
Directory | Exclusions | Plan
information and Enrollment Form
Plan 500 Benefits | Plan
750 Benefits | Plan 1000 Benefits
| Plan 1500 Benefits
Plan 500 Rates | Plan
750 Rates | Plan 1000 Rates | Plan
1500 Rates
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Medical Plan 500 Benefit Summary |
| Lifetime Maximum Benefit |
$2,000,000 |
| Pre-existing Waiting Period, Including Pregnancy |
6 months |
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In Network you pay |
Out of Network you pay |
| Annual Medical Deductible |
$500 |
| Maximum Annual Medical Out of Pocket, excluding medical
deductible, per individual1 |
$1,000 |
$2,000 |
| 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 Room2 |
20% + $100 copay |
20% + $100 copay |
| Ambulance |
20% |
| Maternity |
20% |
40% |
| Diagnostic X-Ray/Lab |
20% |
40% |
| Transplant2 |
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 Services3 |
20% |
Not Covered |
| Mens Health Care Services3 |
20% |
Not Covered |
| Immunizations3 |
20% |
Not Covered |
| Well Baby Care3 |
20% |
Not Covered |
| Well Child Care3 |
20% |
Not Covered |
| Prescription Drugs: No out of pocket maximum on prescription drugs2 & $0 Rx deductible |
| Generic Coinsurance4 |
up to $5 |
| Preferred Brand Coinsurance4 |
up to $40 |
| Non-Prefered Brand Coinsurance |
up to $70 |
1) This is the maximum amount you will pay for covered medical services per individual, per calendar year, excluding the deductibles, before OMIP will begin paying 100% for
covered services.
2)
The emergency room co-pay, out-of-pocket prescription drug payments, transplants performed at noncontracting facilities, and disallowed charges do not apply to the medical
deductible or out-of-pocket maximum.
3)
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. Adult (age 19 and above) immunizations are limited to the following: Influenza (flu), Zostavax (shingles), Pneumococcal (pneumonia), Tetanus/Diphtheria Toxoid, and
Varicella (chicken pox).
4)
$0 co-payment for 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 Web site at www.omip.state.or.us. Not subject to Rx deductible for Plan 1500. 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 OMIP Contract for specific details. Exact terms, conditions, provisions, exclusions, and limitations are defined in the OMIP
contract.
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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.
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HealthNet
Oregon 