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LifeWise Health Plan of Oregon
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Index | Exclusions
& Limitations | Locate
Providers | Brochure & Application
Plan Benefits:
Essentials Benefits | Prime
Benefits | HSA-Qualified Benefits
Plan Rates:
Essentials | Prime | HSA-Qualified
LifeWise Individual and Family Plans
Whether your clients choose the value-packed Essentials plan, the comprehensive Prime plan or the tax-advantaged HSA-Qualified plan they'll get benefits and healthcare coverage that fit their
lifestyle.
Preventive Services in our plans:
- Well-baby and newborn exams
- Routine physicals (for school, sports, work)
- Women's and men's annual exams
- Preventive immunizations (includes HPV vaccine)
- Cervical (PAP), prostate (PSA), and colorectal* cancer screenings
- Infectious disease screenings
- Metabolic, nutrition and endocrine screenings
- Heart and vascular disease screenings
- Musculoskeletal disorder screenings
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Other Important features:
- Prescription drug benefits
- Alternative Care benefits (Chiropractic and Acupuncture)
- Mammography coverage
- Professional office visits coverage (including Urgent Care and Naturopathy)
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*In-Network Benefits are illustrated below.
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Essentials |
Essentials |
Prime |
HSA-Qualified |
HSA-Qualified |
LifeWise Health Plans
Effective starting 9/1/10 |
Plan Summary
Plan Rates |
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| Features |
A good option when you’re looking for a low rate and more up front coverage for routine care needs. This plan provides up front coverage for your first three office visits. |
A good option when you’re looking for a low rate and more up front coverage for routine care needs. This plan provides up front coverage for your first three office visits. |
A benefit-rich plan that includes coverage for generic and brand name prescriptions. A nice option if you’re looking to cover all your bases. |
• Tax-advantaged savings plan
• Lower monthly rates |
• Tax-advantaged savings plan
• Lower monthly rates |
| Individual Deductible |
$1,000 / $2,500 / $5,000 |
$7,500 / $10,000 |
$1,500 / $2,500 / $5,000 |
$3,000 individual
$6,000 family** |
$5,950 individual
$11900 family** |
Coinsurance
(what you pay) |
35% |
40% |
30% |
25% |
0% |
| Coinsurance Maximum |
$7,500 |
$7,500 |
$6,000 |
$2,950 Individual $5,900 Family |
$0 |
Out-of-Pocket Maximum
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Annual deductible +
coinsurance maximum
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Annual deductible +
coinsurance maximum |
Annual deductible +
coinsurance maximum |
Annual deductible +
coinsurance maximum |
Annual deductible +
coinsurance maximum |
Office Visits and
Preventive Exams |
$35 on first 3 visits PCY; additional visits subject to deductible, then 35%. Office visits, preventive exams and naturopathy are shared |
$40 on first 3 visits PCY; additional visits subject to deductible,then 40%. Office visits, preventive exams and naturopathy are shared |
$30 copay on first 4 visits PCY; additional visits subject to deductible, then 30%. Office visits, preventive exams and naturopathy are shared |
Preventive Exams: Dedcutible waived, you pay 25%
Office Visits: Deductible
applies first, then you pay 25% |
Preventive Exams: Dedcutible waived, then covered in full (to allowable amounts)
Office Visits: Deductible, then covered in full |
Alternative Care
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$35 copay (Chiro/Acupuncture - 12 visit limit); $35 on first 3 visits PCY; additional visits subject to deductible, then 35%. Office visits, preventive exams and naturopathy
are shared |
$40 copay (Chiro/Acupuncture - 12 visit limit); $40 on first 3 visits PCY; additional visits subject to deductible, then 40%. Office visits, preventive exams and naturopathy
are shared |
$30 copay on first 4 visits PCY; additional visits subject to deductible, then 30%. Office visits, preventive exams and naturopathy are shared |
Deductible, then 25% |
Deductible, then covered in full |
Pharmacy
(Retail 30-day supply) |
$20 generic only |
$20 generic only |
$20 generic; 50% brand |
Deductible, then 25% ($5,000 PCY limit) |
Deductible, then covered in full ($5,000 PCY limit) |
Pharmacy
(Mail Order 90-day supply) |
$60 generic only |
$60 generic only |
$60 generic; 50% brand |
Deductible, then 25% ($5,000 PCY limit) |
Deductible, then covered in full ($5,000 PCY limit) |
| Maternity |
Prenatal & Postnatal Care: Deductible, then 35% - Routine Delivery: Deductible, then 50% |
Prenatal & Postnatal Care: Deductible, then 40% - Routine Delivery: Deductible, then 50% |
Deductible, then 30% |
Deductible, then 25% |
Deductible, then covered in full |
| Vision Care |
$35 copay (1 exam PCY) |
$35 copay (1 exam PCY) |
$30 copay (1 exam PCY) |
Deductible, then 25% |
Deductible, then covered in full |
* Reimbursable expenses are covered at 100% of maximum allowable amounts; no deductible applies.
** Services for all family members covered under the same HSA-qualified plan are applied to the family deductible. The family deductible must be met before services are covered for any enrolled family members.
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HealthNet
Oregon 