Medical Insurance

Health Insurance Lewis & Clark offers competitive medical insurance plan options so our employees can choose the plan that best meets their needs. Plan benefits, including co-pays and out-of-pocket maximums, vary between the plans. Both plans include prescription drug benefits and basic vision coverage.

PPO Plan: Regence BlueCross/BlueShield of Oregon

HMO Plan: Kaiser Permanente

Retiree Medical: MedAdvantage, Kaiser Sr. Advantage, Companion Plan F

Active Medical Plan Comparison

Plan Name	PEHT PPO Plan	PEHT PPO Plan	Kaiser Permanente
	Regence BlueCross BlueShield Preferred Provider Network	Out-of-Network	In-Network Only
Annual Deductible	Individual - $250 Family - $750	Individual - $500 Family - $1,500	None
Annual Out-of-Pocket Maximum	Individual - $2,000 Family - $6,000	Individual - $6,000 Family - $18,000	Individual - $1,250 Family - $2,500
Lifetime Maximum Benefit	$2,000,000	$2,000,000	None
Office Visits	$20 co-pay	Employee pays 40% after deductible	$15 co-pay
Well Baby Care	$20 co-pay	Employee pays 40% after deductible	No charge
Women's Health Exams	$15 co-pay	$15 co-pay	No charge
Diagnostic Lab & X-ray	Plan pays 100% after deductible	Employee pays 40% after deductible	No charge
Inpatient Stay/Surgery	Employee pays 20% after deductible	Employee pays 40% after deductible	$250 per admission
Outpatient Surgery	Employee pays 20% after deductible	Employee pays 40% after deductible	$15 co-pay
Outpatient Mental Health	$20 co-pay	Employee pays 40% after deductible	$15 co-pay
Urgent facility care	Plan pays 100% after $20 co-pay (deductible waived)	Employee pays 40%	$15 co-pay
Emergency Room	$100 co-pay, then employee pays 20% (deductible waived)	$100 co-pay, then employee pays 20% (deductible waived)	$75 plus any other charges that normally apply
Ambulance Services	Employee pays 20% after deductible	Employee pays 20% after deductible	$75 co-pay
Prescription Retail (up to 30-day supply)	$15 generic/$35 preferred/$55 non-preferred	$15 generic/$35 preferred/$55 non-preferred	$15 generic/$30 brand-name** Kaiser Permanente pharmacies and mail-order only
Prescription Mail Order (up to 90-day supply)	$30 generic/$70 preferred/ $110 non-preferred	$30 generic/$70 preferred/ $110 non-preferred	$30 generic/$60 brand-name** Kaiser Permanente pharmacies and mail-order only
Vision Benefits	Annual exam - $10 co-pay. $62 maximum paid towards single vision lenses & up to $75 for frames every 24 months. No vision network required.	Annual exam - $10 co-pay. $62 maximum paid towards single vision lenses & up to $75 for frames every 24 months. No vision network required.	Routine eye exam - $15 co-pay Prescription eyeglasses & contact lenses - balance after $150 credit every 24 months.** Kaiser Permanente vision providers only

Benefit Terms Explained:

Co-pay: The amount you are expected to pay for a medical expense at the time of your visit.

Deductible: The dollar amount of covered expenses you are responsible to pay the physician or hospital every calendar year before your plan will pay any of your claims.

Out-of-pocket maximum: A cap on how much you have to pay for your family's covered medical expenses in a calendar year. After you reach the out-of-pocket maximum, your plan will pay 100% of all remaining covered expenses for that year. Your individual and family deductibles are counted toward the out-of-pocket maximum; however your co-pays are not counted.

Lifetime maximum: The maximum amount of money your plan will pay towards your health care services over the course of your lifetime.

Coinsurance: The ratio (%) of splitting the medical bill between you and your plan. For example, a 20% coinsurance for a $5,000 claim means that your plan will pay $4,000 and you are responsible for the remaining $1,000.