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Oregon Medical Insurance
Pool (OMIP)
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Benefits: OMIP Plan
750 | OMIP Plan 1000 | OMIP Plan 1500 | FMIP Plan 500 | FMIP Plan 750
Rates: OMIP Plan
750 | OMIP Plan 1000 | OMIP Plan
1500 | FMIP Plan 500 | FMIP Plan 750
Oregon Medical Insurance Pool
OMIP 1500 Medical & Portability Plan Benefits
| |
In Network you pay |
Out of Network you pay |
| Annual Medical Deductible |
$1,500 |
| Maximum Annual Medical Out of Pocket, excluding medical deductible, per individual1 |
$6,000 |
$12,000 |
| Pre-existing Waiting Period, Including Pregnancy |
Medical:
6 months |
Portability:
None |
| Lifetime Maximum Benefit |
$2,000,000 |
| There is no pre-existing wait period for children under the age of 19. |
| Doctor Visits |
30% |
50% |
| Hospital |
30% |
50% |
| Outpatient Surgery |
30% |
50% |
| Skilled Nursing Care - limited to 60 days |
30% |
50% |
| Home Health Care - limited to 130 visits |
30% |
50% |
| Emergency Room2 |
30% + $200 copay |
30% + $200 copay |
| Ambulance |
30% |
| Maternity |
30% |
50% |
| Diagnostic X-Ray/Lab |
30% |
50% |
| Transplant2 |
0% |
50% |
| Hospice |
30% |
50% |
| Rehabilitation Inpatient/Outpatient - limited to 60 days |
30% |
50% |
| Durable Medical Equipment |
30% |
| Mental Health/Chemical Dependency |
30% |
50% |
| Womens Health Care Services3 |
30% |
50% |
| Mens Health Care Services3 |
20% |
Not Covered |
| Immunizations3 |
20% |
Not Covered |
| Well-Baby Care/Well-Child Care 3 |
20% |
Not Covered |
| Preventive Care under the PPACA3 |
0% |
Not Covered |
| Prescription Drugs: Annual
$1,000 Rx Deductible & no out of pocket maximum on prescription drugs2 |
| Generic Co-Insurance4 |
Up to $5 |
| Preferred Brand Co-Insurance4 |
Up to $40 |
| Non-Prefered Brand Co-Insurance |
Up to $70 |
- This is the maximum amount you will pay for covered medical services per individual, per calendar year, excluding the deductibles, before OMIP will begin paying 100% for covered services.
- The emergency room co-pay, out-of-pocket prescription drug payments, transplants performed at noncontracting facilities, and disallowed charges do not apply to the medical deductible or out-of-pocket maximum.
- These services do NOT accumulate towards the maximum annual out-of-pocket expense. Also, you do not have to meet the annual medical deductible before OMIP pays for these services. Coverage is provided only for those preventative care services designated by: The United States Preventive Services Task Force (USPSTF) for services with an A or B rating in the current recommendations; by the Health Resources and Services Administration (HRSA); or by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC).
- $0 co-payment for fluoride, regular aspirin, and iron as specified by the Patient Protection Affordable Care Act and specific diabetic supplies, insulin (excluding pumps), and evidence-based generic maintenance medications as determined by OMIP. A list of these medications can be found on our website at www.omip.state.or.us. This list is subject to change.
This Health Benefit Plan Summary is intended only as a brief summary of our benefit plans. Please refer to the contract for specific details. Exact terms, conditions, provisions, exclusions, and limitations are defined in the contract. But please remember to read through the OMIP packet
carefully before making a decision.
This information is taken from the Oregon Department of Consumer and Business Services web site. Every reasonable effort is made to assure the accuracy of the information provided here. CDA Insurance LLC is a licensed and independent agency that can assist consumers in securing this coverage. |
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