Portability Product: Low Cost Option

To purchase this plan, you must be terminating from one of our Regence Oregon-based group plans:

Coverage at a Glance

Deductible:	$1,500 in-network; $1,500 out-of-network
Annual OOP Max:	Not applicable on this plan
Lifetime Max:	$2 million per member
Copay:	Not applicable on this plan
Coinsurance:	30% in-network; 50% out-of-network
Coinsurance Max:	$6,000 in-network, $10,000 out-of-network
Network(s):	Preferred Provider Plan Network

Prescriptions:	• Generic - $20 copay • Preferred - $40 copay • Non-preferred - $60 copay • $1,000 prescription medication deductible • No annual limit
Preventive Care:	• Deductible and coinsurance • In-network only
Vision:	Not covered
Office Visits:	Deductible and coinsurance
Diagnostic X-ray Services:	Deductible and coinsurance
Outpatient Laboratory Services:	Deductible and coinsurance