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Special Edition
New Oregon Plans Meet Demand for
Additional Low-Cost Options
We are excited to announce that we are adding new, low-cost plans to our family of PacificSource products—CoDeduct Value 70%, CoDeduct Value 80%, and Preferred $15/50%. These streamlined plans, some with unbundled benefits, will offer groups a way to stay within their health insurance budget while offering their employees essential coverage.
CoDeduct Value 70% and CoDeduct Value 80% Plans
These plans provide two lower-cost CoDeduct plan options, and are available to small groups (2–50 eligible employees) effective July 1, 2008. These plans will be available to large groups beginning October 1, 2008.
Features at a glance:
- Higher out-of-pocket (OOP) limits (depending on the deductible)
- More deductible choices—from $300 through $7,500
- Advanced imaging services will require a per-test copay in addition to the medical deductible in most cases. For example, a copay would be charged for each MRI scan. However, since multiple Cath labs are often ordered and performed in one day, one copay would be charged for all of the tests on that day.
- Emergency room copay of $250 (not subject to the deductible)
- Initial lab/x-ray coverage of $400. This coverage is not subject to deductible and is paid at 100 percent. Subsequent lab work will be subject to the plan's medical deductible and coinsurance.
- Lab tests and mammograms, associated with preventive care office visits, will continue to be paid under the preventive care services benefit.
- Professional office visits, urgent care visits, and emergency room services are unbundled. For example, if a surgical procedure is performed in an office setting, the surgery benefit would apply instead of the office visit benefit. Similarly, if lab work or advanced imaging services are performed in the emergency room, the lab or imaging benefits would apply instead of the emergency room benefit.
We've also developed two one-page comparisons:
Preferred $15/50% Plan
This new plan offers coverage similar to the Oregon-mandated Basic Health Plan (BHP), is more cost-effective to administer, and has lower rates than the BHP. This plan is available to all size groups effective July 1, 2008.
Differences from the BHP at a glance:
- Nonparticipating preventive care services will be reimbursed at 50% after the $15 copay.
- The out-of-pocket limit for nonparticipating providers will be $5,000 per person.
- The day and dollar limitations will match our standard Preferred plan contract.
- The covered benefits and exclusions will match our standard Preferred plan contract. For example, hearing aid devices, prescription drugs, and children's dental and eye exams will be excluded.
Our current BHP plan will remain the same and continue to be available to new and existing employer groups. Limitations and exclusions will also remain the same.
Visit our Oregon Plan Summaries page in the For Agents area of our Web site for details. Please feel free to contact us for additional information.
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