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Oregon Medical Insurance > ODS Health Plans of Oregon > Beneficial Value Benefits

HealthNet Health Plans

 
Beneficial Value (PPO)
Plan year deductible
(family deductible is 3x the individual)
$1,000 / $2,500 / $5,000 / $7,500
Out-of-Pocket Maximum, per person
(after deductible)
$5,000
$10,000
Preventive Care
Member Responsibility
In Network
Out of Network
Annual women's exam - pap, pelvic, breast
$25 co-pay*
50%
Women's routine mammogram
$25 co-pay*
50%
Well-baby care
$25 co-pay*
Not covered
Routine physical exams
$25 co-pay*
Not covered
Immunizations
$0 co-pay*
Not covered
Professional Services
Office Visits
First 3 at $25**
50%
Alternative care ($1,000 per plan year limit)
Chiropractic, naturopathic and acupuncture
First 3 at $25**
50%
Facility and Ancillary Services
Hospital - Inpatient and outpatient surgery; room, ancillary and physician charges; skilled nursing facility care
30%
50%
Maternity - All pre/post office visits and doctor delivery; hospital charges
30%
50%
Mental Health ($2,500 maximum in a 12-month period)Inpatient, outpatient, residential combined
30%
50%
Lab and X-ray services; rehabilitation services; medical supplies and devices; in-hospital care; home healthcare
30%
50%
Emergency Services
Urgent Care
First 3 at $25**
50%
Emergency room (deductible applies)
30% after $100 copay
Ambulance ($5,000 per plan year limit)
30%
Other Benefits
Prescription services
Optional***
Lifetime benefit maximum
$2,000,000
$250,000
Accident benefit
Deductible waived for treatment completed within 90 days of accident.
*Deductible waived
** Beneficial plans pay first three office visits with a copayment, which may be used for either office visits or urgent care for illness and injury. Alternative care includes an additional three visits with a copayment. Thereafter, the deductible and coinsurance apply for additional office visits and alternative care.
*** Can purchase a prescription rider separately; benefit is $15 generic or 50% brand, $2,000 maximum benefit; deductible waived.
Note: This is a benefit summary only. For a complete description of benefits, refer to your Policy.

 

 

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