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Regence BreakthruSM 70 - $3,000 Deductible

Oregon Health Plan

    • Coverage begins on day one. You can visit the doctor for a simply copay before using your deductible.
    • Preventive care for everyone is standard, not something you pay extra for.
    • Vision care: you pay a $30 copay for an annual exam and receive up to $150 for glasses and/or contacts.

Coverage at a Glance


Deductible:
Annual OOP Max: Not applicable on this plan
Lifetime Max: $2 million per member
Copay: $30 preferred, $40 non-preferred
Coinsurance: 30% preferred providers, 50% non-preferred
Coinsurance Max: $5,000 per member
Network(s): Preferred Network

Find a Doctor
Yes Prescription benefits
Yes Dental
Yes Vision
Yes No Referrals
Yes Maternity
Yes Preventive Care
Yes Alternative Care
Yes Mental Health
 

Basic Features

Cost Sharing
Deductibles:
  • $3,000 per member
  • Family maximum of three individual deductibles
Annual OOP Max:

Not applicable on this plan
Coinsurance Max:
  • You pay $0 after reaching $5,000 coinsurance maximum per member using preferred providers
  • Family coinsurance maximum of three individual deductibles using preferred providers
  • No maximum when using non-preferred providers
Lifetime Max: $2 million paid by Regence per member
Copay:
  • You pay $30 when using preferred providers
  • You pay $40 and coinsurance when using non-preferred providers
Coinsurance:
  • You pay 30% when using preferred providers
  • You pay 50% when using non-preferred providers
Everyday Needs
Prescriptions:
  • $10 copay for generic medications purchased at the pharmacy
  • $30 copay for generic mail order
  • You pay 30% using the formulary
  • You pay 50% when not using the formulary
  • $3,000 annual limit on all medications
  • No deductible
  • RegenceRx discount program after limit is reached
Preventive Care:
  • You pay coinsurance only
  • No deductible
  • All preventive care services, including related lab tests, screening procedures and x-rays are limited to $200 per calendar year
Vision:
  • One routine eye exam per calendar year
  • You pay $30 copay using preferred providers
  • You pay coinsurance using non-preferred providers
  • You pay $0 up to $150 per calendar year max on vision hardware
Office Visits:
  • You pay $30 copay using preferred providers
  • You pay $40 copay when using non-preferred providers
  • No deductible
Diagnostic x-ray services:
  • Deductible and coinsurance
Outpatient Laboratory services:
  • Deductible and coinsurance
Special Needs
Alternative care:
  • Covered as any other condition
  • Acupuncture limited to 12 visits per calendar year maximum
  • Spinal manipulations limited to 10 manipulations per calendar year maximum
Maternity:
  • Deductible and coinsurance
Mental Health:
  • Covered as any other condition
  • Inpatient: 8 days per calendar year
  • Outpatient: 12 visits per calendar year
Other considerations
Network(s):

Preferred Providers

  • Preferred Provider Plan (PPP) Network (most medical services)
  • Participating (PAR) Vision Network (vision only)
  • Washington Supplemental Providers (alternative care only)

Non-Preferred Providers

  • Providers outside of the preferred network

Benefit Summary

Rates

Optional Benefits

Complete your health care plan with Dental coverage: Individual Dentacare
  • No deductibles, no annual maximums
  • $15 per visit copay for basic dental services
Learn more about Individual Dentacare »

Medical Exclusions and Limitations

Acupuncture 12 visits per calendar year
Alcoholism Not covered
Ambulance $2,000 annual limit for non-emergencies, ground and air
Cosmetic/Reconstructive Surgery Not covered
Custodial Care and Rest Cures Not covered
Drug Abuse/Addiction Treatment Not covered
Durable Medical Equipment $2,500 annual limit
Family Planning Not covered
Growth Hormone Benefit $25,000 annual limit
Hearing Aids Not covered
Home Health Care 130 days per calendar year
Maternity 9-month waiting period for labor & delivery
Mental Health Treatment Inpatient: 8 days per calendar year
Outpatient: 12 visits per calendar year
Obesity or Weight Control Not covered
Orthognathic Surgery Not covered
Rehabilitative Care (inpatient) $4,000 annual limit
Rehabilitative Care (outpatient) $2,000 annual limit
Skilled Nursing Facility 30 days per calendar year
Spinal Manipulation

10 spinal manipulations per calendar year

 
Temporomandibular Joint Disorder Not covered
Transplants
  • $250,000 lifetime maximum
  • 12-month waiting period
Tobacco Addiction Treatment Not covered
Vision Limited to one exe exam and $250 hardware per calendar year
You must be covered for at least 9 months before we pay for any of the following
Allergies 9-month waiting period
Ear Infections (otitis media) 9-month waiting period
Pre-existing conditions 9-month waiting period
Removal of Tonsils and Adenoids 9-month waiting period
Sterilization 9-month waiting period
This does not include all benefits, limitations, exclusions and other terms of coverage (such as eligibility and cancellation provisions) applicable to this plan. Please refer to your contract of a complete list and more in-depth explanation of benefits and the limitations and exclusions that apply.

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