Portability Product: Prevailing Option

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

Coverage at a Glance

Deductible:	$750 in-network; $750 out-of-network
Annual OOP Max:	Not applicable on this plan
Lifetime Max:	$2 million per member
Copay:	Not applicable on this plan
Coinsurance:	20% in-network; 40% out-of-network
Coinsurance Max:	$3,000 in-network, $6,000 out-of-network
Network(s):	Preferred Provider Plan Network

Prescriptions:	• Generic - $20 copay • Preferred - $40 copay • Non-preferred - $60 copay • No 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