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Regence BlueCross BlueShield of Oregon Health Savings
Account Benefit Description.
New
Rates 7-1-2009
You can check to see if your health care professional is a
participating provider in the Regence
BlueCross of Oregon Preferred Care Directory
(NOTE: This will open a new browser window for the search. When you are
finished, just close that window.)
The following is a very brief outline of the plan's features. For
complete information including limitations and exclusions, please
contact us and request a Summary of Benefits for this plan
| |
Blue
Selections Basic |
| Lifetime
benefit maximum |
$2,000,000 |
| Single
Annual
Deductibles |
$1,500,
$2,500, $3,500, |
| Single
Out-of-Pocket Maximum |
$5000
in network, No maximum if out of network, includes deductible. |
| Annual
Family deductible |
$3,000,
$5,000, $7000 |
| Family
Out-of-Pocket Maximum |
$10,000
in network, No maximum if out of network, includes deductible. |
| |
In-Network |
Out-Of-Network |
| |
| NOT
SUBJECT to DEDUCTIBLE |
| Routine
Care |
80% |
60% |
| Annual
Men's Exams |
80% |
60% |
| Annual
women's exams |
80% |
60% |
| Well-Baby
/Child |
80% |
60% |
| Adult
and Child Immunizations |
80% |
60% |
|
Professional
Services after the deductible we pay for covered services |
|
Maternity
care |
80% |
60% |
| Office
visits and Urgent Care visits |
80% |
60% |
|
Hospital
Services |
| Hospital
stay |
80% |
60% |
| Skilled
Nursing |
80% |
60% |
| Inpatient
Rehabilitation |
80% |
60% |
| Inpatient
Mental Illness |
80% |
60% |
| Emergency
Room Services |
80% |
| Other
Services and Benefits |
| Additional
Accident |
80% |
60% |
| Ambulance |
80% |
| Laboratory
and Radiology services |
80% |
60% |
| Outpatient
Rehabilitation |
80% |
60% |
| Home
Health Services |
80% |
60% |
| Alcoholism |
80% |
60% |
| Transplant
services |
100% |
| Durable
medical equipment and supplies |
80% |
60% |
| Accidental
death |
$25,000
for subscriber and spouse, $5,000 for dependent or child
subscriber . |
|
Prescription Medications
|
| Deductible |
Deductible
applies |
| Coinsurance |
50% |
Rates as of 7-1-2009
|
|
HSA
Plan rates for an individual
|
|
Age
|
Individual $1500
Deductible
|
Individual
$2500
Deductible
|
Individual $3500
Deductible
|
|
0-17
|
101
|
85
|
76 |
|
18-20
|
132
|
112
|
100
|
|
21-24
|
159
|
135
|
120
|
|
25-29
|
170
|
144
|
128
|
|
30-34
|
194
|
164
|
146
|
|
35-39
|
207
|
175
|
156
|
|
40-44
|
265
|
225
|
200
|
|
45-49
|
313
|
265
|
236
|
|
50-54
|
364
|
308
|
274
|
|
55-59
|
438
|
371
|
330
|
|
60+
|
505
|
427
|
380
|
|
|
HSA
Plan $3,000 Family Deductible
|
|
Age
|
Individual
& Spouse
|
One
Adult & Child(ren)
|
Family
|
|
0-17
|
N/A
|
N/A
|
N/A
|
|
18-20
|
265
|
234
|
366
|
|
21-24
|
319
|
260
|
420
|
|
25-29
|
340
|
271
|
441
|
|
30-34
|
388
|
295
|
489
|
|
35-39
|
414
|
308
|
515
|
|
40-44
|
531
|
366
|
632
|
|
45-49
|
627
|
414
|
728
|
|
50-54
|
728
|
465
|
829
|
|
55-59
|
877
|
539
|
978
|
|
60+
|
1010
|
606
|
1111
|
|
|
HSA
Plan $5,000 Family Deductible
|
|
Age
|
Individual
& Spouse
|
One
Adult & Child(ren)
|
Family
|
|
0-17
|
N/A
|
N/A
|
N/A
|
|
18-20
|
225
|
198
|
310
|
|
21-24
|
270
|
220
|
355
|
|
25-29
|
288
|
229
|
373
|
|
30-34
|
328
|
249
|
414
|
|
35-39
|
351
|
261
|
436
|
|
40-44
|
450
|
310
|
535
|
|
45-49
|
531
|
351
|
616
|
|
50-54
|
616
|
393
|
702
|
|
55-59
|
742
|
456
|
828
|
|
60+
|
855
|
513
|
940
|
|
|
HSA
Plan $7,000 Family Deductible
|
|
Age
|
Individual
& Spouse
|
One
Adult & Child(ren)
|
Family
|
|
0-17
|
N/A
|
N/A
|
N/A
|
|
18-20
|
200
|
176
|
276
|
|
21-24
|
240
|
196
|
316
|
|
25-29
|
256
|
204
|
332
|
|
30-34
|
292
|
222
|
368
|
|
35-39
|
312
|
232
|
388
|
|
40-44
|
400
|
276
|
476
|
|
45-49
|
472
|
312
|
548
|
|
50-54
|
548
|
350
|
624
|
|
55-59
|
660
|
406
|
736
|
|
60+
|
760
|
456
|
837
|
|
Please contact
us to request that a Summary of Benefits and application for
this plan be sent to you. Don't forget to give us your mailing
address.
Privacy Statement- This request
will be absolutely
confidential. The information will not be sold,
given away or used for any other purpose but to mail or email
requested information.
Information Request Form
This is not an application for insurance. In the state
of Oregon, Individual Health Insurance plans must be approved in
the underwriting stage of the insurance application. This
might take a few weeks to complete. Please leave your name
address and questions and any information that you would like.
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