Oregons Health CO-OP

Oregons Health CO-OP | SiMPLEsilver Select Network

  • SiMPLEsilver Select Network is an Obamacare health insurance plan offered by Oregons Health CO-OP that is available for individuals and families.

  • This plan is a PPO, meaning you will have the flexibility to visit a preferred healthcare provider network that have preferred rates for in-network physicians. (Read more about PPOs.)

  • This plan is a Silver metal level plan, which generally has a mid-level monthly cost and deductible (and co-pay), and provides middle-of-the-road insurance coverage for people who occasionally use their health care benefits (doctors, prescription drugs, etc.).

  • Deductible amount of Not Applicable. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

  • Max out-of-pocket of $6,850, which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.


Ways to Enroll or Learn More

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Plan Summary

Monthly Cost

Plan Name:
SiMPLEsilver Select Network

Plan ID:
99389OR0650001

Plan Type:
PPO

Deductible:
Not Applicable

Maximum Out-of-Pocket:
$6,850

Summary of Benefits:

Provider Information:

Who is this plan for?

This plan with a moderate monthly cost is great for individuals and families who occasionally visit the doctor or use prescription drugs. The low deductible on this plan means you won't have to pay as much money out of pocket for medical care and prescriptions before your insurance kicks in. The very high out-of-pocket maximum on this plan means you could be faced with a very expensive medical bill if an emergency happens. Plans with this type of provider network tend to have a more broad provider network.

HealthCare.com is a privately-held internet start-up for healthcare consumers. We’re not the government website.

Highlights


Dental Coverage:
Child

Emergency Room:
$500

Retail Drugs:
$70

Generic Drugs:
$15

Overview


Plan Type:
PPO

Metal Level:
Silver

Health Spending Account:
No

Primary Care Office Visit:
$35

Specialist Office Visit:
$55

Out of Network Coverage:
No

Out of Country Coverage:
No

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
Not Covered
Well Baby Care
In Network:
No Charge

Out of Network:
Not Covered

Inpatient

Hospital Services
In Network:
$5,000 Copay per Stay

Out of Network:
50%
Physician Fee
In Network:
No Charge

Out of Network:
50%
Skilled Nursing Facility
In Network:
$3,000 Copay per Stay

Out of Network:
50%
Mental Health
In Network:
$5,000 Copay per Stay

Out of Network:
50%
Substance Abuse
In Network:
$5,000 Copay per Stay

Out of Network:
50%
Home Healthcare
In Network:
No Charge

Out of Network:
50%

Outpatient

Surgery
In Network:
No Charge

Out of Network:
50%
X-ray and Diagnostics
In Network:
$50

Out of Network:
50%
Labs
In Network:
$50

Out of Network:
50%
Facility Fee
In Network:
$4,600

Out of Network:
50%
Mental Health
In Network:
$35

Out of Network:
50%
Substance Abuse
In Network:
$35

Out of Network:
50%
Rehabilitation Services
In Network:
$35

Out of Network:
50%

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
No Charge

Out of Network:
Not Covered
Labor and Delivery Inpatient Services
In Network:
$5,000

Out of Network:
50%

Dental

Accidental Care
In Network:
$500

Out of Network:
$500
Dental Checkup (Child)
In Network:
Not Covered

Out of Network:
Not Covered

Vision

Eye Exam (Child)
In Network:
No Charge

Out of Network:
Not Covered
Glasses (Child)
In Network:
No Charge

Out of Network:
Not Covered

Additional Coverage

Chiropractic Care
In Network:
$35

Out of Network:
Not Covered
Habilitation Services
In Network:
$5,000

Out of Network:
50%
Rehabilitation Services (Speech)
In Network:
$35

Out of Network:
50%
Rehabilitation Services (Occupational Therapy)
In Network:
$35

Out of Network:
50%
Hospice Service
In Network:
No Charge

Out of Network:
50%
Diabetes Care Management
In Network:
$35

Out of Network:
50%
Durable Medical Equipment
In Network:
$70

Out of Network:
Not Covered
Hearing Aids
In Network:
$70

Out of Network:
Not Covered
Nutritional Consuleling
In Network:
$55

Out of Network:
50%
Cosmetic Surgery
In Network:
$5,000

Out of Network:
50%
Reconstructive Surgery
In Network:
$5,000

Out of Network:
50%

Doctor Visits

Primary Care Visit
In Network:
$35

Out of Network:
Not Covered
Specialist Visit
In Network:
$55

Out of Network:
50%
Other Practitioner Office Visit
In Network:
$35

Out of Network:
50%
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
Not Covered

Emergency Room and Urgent Care

Emergency Room Services
In Network:
$500

Out of Network:
$500
Urgent Care Services
In Network:
$75

Out of Network:
50%
Ambulance/Transportation Services
In Network:
$250

Out of Network:
50%

Drugs

Generic Prescription
In Network:
$15

Out of Network:
Not Covered
Retail Brand Drugs
In Network:
$70

Out of Network:
Not Covered
Non Retail Brand Drugs
In Network:
$140

Out of Network:
Not Covered
Specialty Drugs
In Network:
50%

Out of Network:
Not Covered

Additional Plan Information

Summary Of Benefits:

Provider Information:

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only. Your monthly premium may change based on the data provided, outside fees, optional benefits or if other factors take effect before your coverage start date. Note that insurance companies reserve the right to change your premium rate and the policy terms at any time. Effective date, benefit amounts and other conditions may apply at the discretion of the insurance carrier you select. Depending on your state of residence, this website may not display all plans available by state. The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy eligibility may differ. Access to your physician depends on network selected, and networks can change without notice. Contact your health insurance company to confirm your healthcare provider is still available in the network you select.

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