PROVIDENCE HEALTH PLAN*

PROVIDENCE HEALTH PLAN* | Providence Oregon Standard Gold Plan

  • Providence Oregon Standard Gold Plan is an Obamacare health insurance plan offered by PROVIDENCE HEALTH PLAN* that is available for individuals and families.

  • This plan is a EPO, meaning you will have some of the flexibility to manage more of your health care without a primary care physician, however, you will need to stay within the provider’s network. (Read more about EPOs.)

  • This plan is a Gold metal level plan, which generally has a higher monthly cost but lower deductible (and co-pay), and provides good insurance coverage for people and families who spend more on health care (doctor visits, Rx, tests) than the average person.

  • Deductible amount of $1,250. 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 $6,350, 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:
Providence Oregon Standard Gold Plan

Plan ID:
56707OR0990002

Plan Type:
EPO

Deductible:
$1,250

Maximum Out-of-Pocket:
$6,350

Summary of Benefits:

Provider Information:

Who is this plan for?

This plan with a higher monthly cost is great for individuals and families who have multiple, serious, or chronic health needs, regularly visit the doctor, and regularly use multiple 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.

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Highlights


Emergency Room:
10% Coinsurance after deductible

Retail Drugs:
$30

Generic Drugs:
$10

Overview


Plan Type:
EPO

Metal Level:
Gold

Health Spending Account:
No

Primary Care Office Visit:
$20

Specialist Office Visit:
$40

Out of Network Coverage:
Yes

Out of Country Coverage:
Yes

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible
Well Baby Care
In Network:
No Charge

Out of Network:
50% Coinsurance after deductible

Inpatient

Hospital Services
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Physician Fee
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Skilled Nursing Facility
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Mental Health
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Substance Abuse
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Home Healthcare
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

Outpatient

Surgery
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
X-ray and Diagnostics
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Labs
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Facility Fee
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Mental Health
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Substance Abuse
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services
In Network:
$20

Out of Network:
50% Coinsurance after deductible

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Labor and Delivery Inpatient Services
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

Dental

Accidental Care
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible

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

Habilitation Services
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services (Speech)
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Rehabilitation Services (Occupational Therapy)
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Hospice Service
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Diabetes Care Management
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Durable Medical Equipment
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Hearing Aids
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Nutritional Consuleling
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Cosmetic Surgery
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Reconstructive Surgery
In Network:
10% Coinsurance after deductible

Out of Network:
50% Coinsurance after deductible
Outside US Non-emergency Care
In Network:
Not Covered

Out of Network:
50% Coinsurance after deductible

Doctor Visits

Primary Care Visit
In Network:
$20

Out of Network:
50% Coinsurance after deductible
Specialist Visit
In Network:
$40

Out of Network:
50% Coinsurance after deductible
Other Practitioner Office Visit
In Network:
$20

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

Out of Network:
50% Coinsurance after deductible

Emergency Room and Urgent Care

Emergency Room Services
In Network:
10% Coinsurance after deductible

Out of Network:
10% Coinsurance after deductible
Urgent Care Services
In Network:
$60

Out of Network:
50% Coinsurance after deductible
Ambulance/Transportation Services
In Network:
10% Coinsurance after deductible

Out of Network:
10% Coinsurance after deductible

Drugs

Generic Prescription
In Network:
$10

Out of Network:
Not Covered
Retail Brand Drugs
In Network:
$30

Out of Network:
Not Covered
Non Retail Brand Drugs
In Network:
50%

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

Out of Network:
Not Covered
Drug Deductible
In Network:
Individual: No Charge Family: No Charge

Out of Network:
Individual: No Charge Family: No Charge

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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