PacificSource - PacificSource Oregon Standard Bronze Plan SCN

Oregon, 2019

  • Plan Type

    PPO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $6,550

  • Deductible

    $6,550

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $6,550
Deductible (Family) $13,100
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,550
Out of Pocket Maximum (Family) $13,100

Doctor Visits

Primary Care Visit No charge after deductible
Specialist Visit No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible
Emergency Room Services No charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) No charge after deductible
Laboratory Outpatient and Professional Services No charge after deductible
X-Ray and Diagnostic Imaging No charge after deductible

Health Management Programs

Asthma Available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient No charge after deductible
Rehabilitative Speech Therapy No charge after deductible
Rehabilitative Occupational & Physical Therapy No charge after deductible
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx No charge after deductible
Preferred Brand Rx No charge after deductible
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

Other Plans in Oregon

Plan PacificSource Oregon Standard Silver Plan SCN Deductible $2,850 Coinsurance Not applicable Out of Pocket $7,900
Plan Legacy Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan PacificSource Oregon Standard Gold Plan SCN Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,850
Plan SmartChoice Bronze HSA 6650 Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan PacificSource Oregon Standard Gold Plan LHN Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,850
Plan PacificSource Oregon Standard Bronze Plan LHN Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan PacificSource Oregon Standard Silver Plan LHN Deductible $2,850 Coinsurance Not applicable Out of Pocket $7,900
Plan Legacy Bronze HSA 6650 Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan SmartChoice Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $6,550
Deductible (Family) $13,100
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,550
Out of Pocket Maximum (Family) $13,100

Doctor Visits

Primary Care Visit No charge after deductible
Specialist Visit No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible
Emergency Room Services No charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) No charge after deductible
Laboratory Outpatient and Professional Services No charge after deductible
X-Ray and Diagnostic Imaging No charge after deductible

Health Management Programs

Asthma Available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient No charge after deductible
Rehabilitative Speech Therapy No charge after deductible
Rehabilitative Occupational & Physical Therapy No charge after deductible
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx No charge after deductible
Preferred Brand Rx No charge after deductible
Non Preferred Brand Rx No charge after deductible
Specialty Drugs No charge after deductible

Other Plans in Oregon

Plan PacificSource Oregon Standard Silver Plan SCN Deductible $2,850 Coinsurance Not applicable Out of Pocket $7,900
Plan Legacy Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan PacificSource Oregon Standard Gold Plan SCN Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,850
Plan SmartChoice Bronze HSA 6650 Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan PacificSource Oregon Standard Gold Plan LHN Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,850
Plan PacificSource Oregon Standard Bronze Plan LHN Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan PacificSource Oregon Standard Silver Plan LHN Deductible $2,850 Coinsurance Not applicable Out of Pocket $7,900
Plan Legacy Bronze HSA 6650 Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,650
Plan SmartChoice Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900