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PacificSource Health Insurance
Oregon Health Insurance
PacificSource Health Insurance
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PacificSource Health Insurance


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Index | Plan Limitations | Locate Providers | Brochure & Application
Plan Benefits:
Elect Premiere | Elect Preferred | Elect FlexPerks | Elect Value Option
Plan Rates:
Elect Premiere | Elect Preferred | Elect FlexPerks | Elect Value Option

Specific Benefit Limitations

Ambulance service - ground 300 miles/year; air $6,000/year
Cardiac rehabilitation (phase II)—$1,000/lifetime
Chiropractic manipulation (covered under Elect Plus only)—12 visits/year
Dietary/nutritional counseling for anorexia or bulimia—5 visits/lifetime
Durable medical equipment—$7,500/lifetime
Flu vaccine (covered under Elect Plus and FlexPerks only)—$20/year
Hospice or respite care—$10,000/lifetime
Mental health treatment (inpatient)—$1,000/lifetime
Naturopathic and acupuncture care (covered under ElectPlus only)—$1,000/year combined
Physical therapy—20 visits/year
Prescription drug expense—does not accumulate toward out-of-pocket limit on the Elect Plus and Elect Value
Pulmonary rehabilitation—$1,000/lifetime
Routine physical exams—(covered under Elect Plus and FlexPerks only)—scheduled.
Speech therapy—$1,000/year
Transplants—$250,000/lifetime
Transplants, travel/housing for recipient—$5,000/transplant
Transplants, nonparticipating providers—$100,000
Well baby exams (covered under Elect Plus and FlexPerks only)—9 exams in the first 24 months of life, including a standard in-hospital exam at birth and related laboratory tests.

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