2017 Oregon Individual and Family Plans

The information on this page is for plans beginning January 1, 2017.  

Medical Plans

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

Medical policy samples by plan and network:


Plan

Deductible*

Out-of-pocket limit*

Co-pay for office visits

Co-insurance after deductible

SBCs
by Network
Summaries
by Network
Standard Bronze
$7,150 
$7,150 
$70 co-pay^
No charge
Standard Bronze (0)*** 
$0
$0
No charge
No charge
Standard Bronze (AI)***
$7,150 
$7,150 
$70 co-pay^
No charge
Standard Silver
$2,500
$6,850
$35 co-pay^
30%
Standard Silver (0)***
$0
$0
No charge
No charge
Standard Silver (AI)***
$2,500
$6,850
$35 co-pay^
30%
Standard Silver (73)**
$2,500
$4,750
$35 co-pay^
30%
Standard Silver (87)**
$850
$1,650
$15 co-pay^
10%
Standard Silver (94)**
$100
$750
$10 co-pay^
10%
Standard Gold
$1,000
$6,850
$20 co-pay^
20%
Standard Gold (0)***
$0
$0
No charge
No charge
Standard Gold (AI)***
$1,000
$6,850
$20 co-pay^
20%
Catastrophic
$7,150 
$7,150 
No charge+
No charge

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

**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.

^Not subject to annual deductible.

+The first three primary care practitioner (PCP) Office and home visits office visits combined are paid at 100 percent. After that, PCP office visits are subject to deductible and co-insurance.

 

Dental Plans


Dental Advantage 0/20/50 - Sample policy
Kids Dental Advantage 0/20/50 - Sample policy
Dental Advantage Essentials Core - Sample policy

 

Rates


Oregon Individual and Family Plan Rates

 

Brochures and Enrollment Forms


Oregon Individual and Family Plan Brochure

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

Order printed materials today >  

 

 Brochures:

Enrollment Forms:  

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

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

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.