2019 Oregon Individual and Family Plans

The information on this page is for plans beginning January 1, 2019.  

Medical Plans


All plans are available direct with PacificSource and through OregonHealthcare.gov .

Medical policy samples by plan and network (PDFs): 

Plan

Deductible^

Out-of-pocket limit^

Preventive Services
No deductible, member pays:

Office Visits
After deductible, member pays:

SBCs (PDFs)
by Network
Summaries (PDFs)
by Network
Bronze HSA 6650 $6,650 $6,650 Covered in Full Covered in Full SmartChoice /
Legacy
SmartChoice /
Legacy
Bronze 6650 (0)*** $0 $0 Covered in Full Covered in Full SmartChoice /
Legacy
SmartChoice /
Legacy
Bronze 6650 (AI)*** $6,650 $6,650 Covered in Full Covered in Full SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Gold $1,000 $6,850 Covered in Full Primary: $20 co-pay*
Urgent Care: $60 co-pay*
Specialist: $40 co-pay*
SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Gold (0)*** $0 $0 Covered in Full Covered in Full SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Gold (AI)*** $1,000 $6,850 Covered in Full Primary: $20 co-pay* 
Urgent Care: $60 co-pay* 
Specialist: $40 co-pay*
SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Silver $2,850 $7,900 Covered in Full Primary: $40 co-pay*
Urgent Care: $70 co-pay*
Specialist: $80 co-pay*
SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Silver (0)*** $0 $0 Covered in Full Covered in Full SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Silver (AI)*** $2,850 $7,900 Covered in Full Primary: $40 co-pay* 
Urgent Care: $70 co-pay* 
Specialist: $80 co-pay*
SmartChoice /
Legacy  
SmartChoice /
Legacy
Standard Silver (73)** $2,850 $6,300 Covered in Full Primary: $40 co-pay* 
Urgent Care: $70 co-pay* 
Specialist: $70 co-pay*
SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Silver (87)** $850 $2,350 Covered in Full Primary: $15 co-pay* 
Urgent Care: $40 co-pay* 
Specialist: $30 co-pay*
SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Silver (94)** $100 $900 Covered in Full Primary: $10 co-pay* 
Urgent Care: $30 co-pay* 
Specialist: $20 co-pay*
SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Bronze $6,550 $6,550 Covered in Full Covered in Full SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Bronze (0)*** $0 $0 Covered in Full Covered in Full SmartChoice /
Legacy
SmartChoice /
Legacy
Standard Bronze (AI)*** $6,550 $6,550 Covered in Full Covered in Full SmartChoice /
Legacy  
SmartChoice /
Legacy
Catastrophic+ $7,900 $7,900 Covered in Full Primary visits 1–3 no deductible. Visits 4+ covered in full after deductible.
Urgent Care/Specialist: Covered in Full
SmartChoice /
Legacy
SmartChoice /
Legacy

^Deductible and out-of-pocket limit amounts shown above are the costs for individuals. Amounts for families are twice the individual amounts.

*Not subject to the deductible.

**This is a cost-sharing plan. Cost-sharing plans are only available to those who qualify financially and enroll through HealthCare.gov.

***The Affordable Care Act (ACA) has special provisions for members of federally recognized American Indian tribes that purchase healthcare coverage through the Marketplace, including zero-cost health services for those whose income is at or below 300 percent of the Federal Poverty Level. Please note that even with a zero cost-sharing plan, out-of-network providers can bill for the amount over the network rate.

+Only available for people under 30, or people of any age with a hardship exemption or affordability exemption.

  

Dental Plans (PDFs)


Dental Advantage 0-20-50 1000 - Sample policy
Dental Advantage 0-20-50 1500 - Sample policy
Kids Dental Advantage 0-20-50 - Sample policy

 

Rates 


2019 Oregon Individual and Family Plan Rates (PDF)

 

Brochures and Enrollment Forms 


Brochures: 

  IFP101_080918_Oregon_Medical_Individual_cover

You can order sales packets for individual and small group clients online!

Order printed materials today > 

Brochures (PDFs): 

Enrollment Forms (PDFs):  

Enroll Online:  

Visit our Oregon Forms and Materials page for more sales materials.

 

Network Availability (Medical)


Network availability varies depending on geographic location. 

SmartChoice Network

 

Availability: If an individual or family lives in one of the following counties, they can choose a plan on the SmartChoice Network:

  • Crook
  • Deschutes
  • Jefferson
  • Lane

Notable features: The SmartChoice Network is designed to give members a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care for members at a lower cost.

 

Legacy Health Network

 

Availability: If an individual or family lives in one of the following counties, they can choose a plan on the Legacy Health Network:

  • Clackamas
  • Multnomah
  • Washington
  • Yamhill

Notable features: The Legacy Health Network is designed to give members a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care for members at a lower cost.