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Index | Exclusions | Provider Directory | ApplicationPlan Benefits:
Optimum Benefits | Value Benefits | Prime Benefits | HSA Benefits
Plan Rates:
Optimum Rates | Value Rates | Prime Rates | HSA Rates
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Other Insurance
Oregon Medical Insurance > HSA Plan >
Effective date : 11/1/2009
Valid thru : 10/31/2010
Counties : Benton, Clackamas, Columbia, Crook, Deschutes, Grant, Harney, Jefferson, Klamath, Lane, Linn, Marion, Multnomah, Polk, Washington, Wheeler, Yamhill
| Family Status : | Applicant | Applicant and Spouse | Applicant and Child(ren) | Applicant and Family |
| Age | Deductible : 2500 | |||
| 0-17 | 109.00 | N/A | N/A | N/A |
| 18-20 | 141.00 | N/A | N/A | N/A |
| 21-24 | 168.00 | N/A | N/A | N/A |
| 25-29 | 182.00 | N/A | N/A | N/A |
| 30-34 | 208.00 | N/A | N/A | N/A |
| 35-39 | 222.00 | N/A | N/A | N/A |
| 40-44 | 283.00 | N/A | N/A | N/A |
| 45-49 | 334.00 | N/A | N/A | N/A |
| 50-54 | 387.00 | N/A | N/A | N/A |
| 55-59 | 466.00 | N/A | N/A | N/A |
| 60-64 | 535.00 | N/A | N/A | N/A |
| Age | Deductible : 3500 | |||
| 0-17 | 101.00 | N/A | N/A | N/A |
| 18-20 | 131.00 | N/A | N/A | N/A |
| 21-24 | 156.00 | N/A | N/A | N/A |
| 25-29 | 169.00 | N/A | N/A | N/A |
| 30-34 | 192.00 | N/A | N/A | N/A |
| 35-39 | 206.00 | N/A | N/A | N/A |
| 40-44 | 262.00 | N/A | N/A | N/A |
| 45-49 | 310.00 | N/A | N/A | N/A |
| 50-54 | 359.00 | N/A | N/A | N/A |
| 55-59 | 433.00 | N/A | N/A | N/A |
| 60-64 | 495.00 | N/A | N/A | N/A |
| Age | Deductible : 5000 | |||
| 0-17 | N/A | N/A | N/A | N/A |
| 18-20 | N/A | 262.00 | 196.00 | 367.00 |
| 21-24 | N/A | 315.00 | 236.00 | 440.00 |
| 25-29 | N/A | 339.00 | 254.00 | 500.00 |
| 30-34 | N/A | 385.00 | 289.00 | 579.00 |
| 35-39 | N/A | 413.00 | 310.00 | 610.00 |
| 40-44 | N/A | 527.00 | 394.00 | 764.00 |
| 45-49 | N/A | 622.00 | 466.00 | 777.00 |
| 50-54 | N/A | 722.00 | 541.00 | 830.00 |
| 55-59 | N/A | 868.00 | 651.00 | 998.00 |
| 60-64 | N/A | 996.00 | 747.00 | 1095.00 |
| Age | Deductible : 7000 | |||
| 0-17 | N/A | N/A | N/A | N/A |
| 18-20 | N/A | 241.00 | 180.00 | 338.00 |
| 21-24 | N/A | 289.00 | 217.00 | 405.00 |
| 25-29 | N/A | 313.00 | 234.00 | 461.00 |
| 30-34 | N/A | 355.00 | 266.00 | 533.00 |
| 35-39 | N/A | 379.00 | 284.00 | 560.00 |
| 40-44 | N/A | 484.00 | 363.00 | 702.00 |
| 45-49 | N/A | 572.00 | 429.00 | 715.00 |
| 50-54 | N/A | 664.00 | 497.00 | 764.00 |
| 55-59 | N/A | 799.00 | 599.00 | 919.00 |
| 60-64 | N/A | 917.00 | 687.00 | 1008.00 |
HSA Plan Rates
Effective date : 11/1/2009
Valid thru : 10/31/2010
Counties : Benton, Clackamas, Columbia, Crook, Deschutes, Grant, Harney, Jefferson, Klamath, Lane, Linn, Marion, Multnomah, Polk, Washington, Wheeler, Yamhill
| Family Status : | Applicant | Applicant and Spouse | Applicant and Child(ren) | Applicant and Family |
| Age | Deductible : 2500 | |||
| 0-17 | 109.00 | N/A | N/A | N/A |
| 18-20 | 141.00 | N/A | N/A | N/A |
| 21-24 | 168.00 | N/A | N/A | N/A |
| 25-29 | 182.00 | N/A | N/A | N/A |
| 30-34 | 208.00 | N/A | N/A | N/A |
| 35-39 | 222.00 | N/A | N/A | N/A |
| 40-44 | 283.00 | N/A | N/A | N/A |
| 45-49 | 334.00 | N/A | N/A | N/A |
| 50-54 | 387.00 | N/A | N/A | N/A |
| 55-59 | 466.00 | N/A | N/A | N/A |
| 60-64 | 535.00 | N/A | N/A | N/A |
| Age | Deductible : 3500 | |||
| 0-17 | 101.00 | N/A | N/A | N/A |
| 18-20 | 131.00 | N/A | N/A | N/A |
| 21-24 | 156.00 | N/A | N/A | N/A |
| 25-29 | 169.00 | N/A | N/A | N/A |
| 30-34 | 192.00 | N/A | N/A | N/A |
| 35-39 | 206.00 | N/A | N/A | N/A |
| 40-44 | 262.00 | N/A | N/A | N/A |
| 45-49 | 310.00 | N/A | N/A | N/A |
| 50-54 | 359.00 | N/A | N/A | N/A |
| 55-59 | 433.00 | N/A | N/A | N/A |
| 60-64 | 495.00 | N/A | N/A | N/A |
| Age | Deductible : 5000 | |||
| 0-17 | N/A | N/A | N/A | N/A |
| 18-20 | N/A | 262.00 | 196.00 | 367.00 |
| 21-24 | N/A | 315.00 | 236.00 | 440.00 |
| 25-29 | N/A | 339.00 | 254.00 | 500.00 |
| 30-34 | N/A | 385.00 | 289.00 | 579.00 |
| 35-39 | N/A | 413.00 | 310.00 | 610.00 |
| 40-44 | N/A | 527.00 | 394.00 | 764.00 |
| 45-49 | N/A | 622.00 | 466.00 | 777.00 |
| 50-54 | N/A | 722.00 | 541.00 | 830.00 |
| 55-59 | N/A | 868.00 | 651.00 | 998.00 |
| 60-64 | N/A | 996.00 | 747.00 | 1095.00 |
| Age | Deductible : 7000 | |||
| 0-17 | N/A | N/A | N/A | N/A |
| 18-20 | N/A | 241.00 | 180.00 | 338.00 |
| 21-24 | N/A | 289.00 | 217.00 | 405.00 |
| 25-29 | N/A | 313.00 | 234.00 | 461.00 |
| 30-34 | N/A | 355.00 | 266.00 | 533.00 |
| 35-39 | N/A | 379.00 | 284.00 | 560.00 |
| 40-44 | N/A | 484.00 | 363.00 | 702.00 |
| 45-49 | N/A | 572.00 | 429.00 | 715.00 |
| 50-54 | N/A | 664.00 | 497.00 | 764.00 |
| 55-59 | N/A | 799.00 | 599.00 | 919.00 |
| 60-64 | N/A | 917.00 | 687.00 | 1008.00 |
* - not all of the zip codes are eligible in this county
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