As of FALL 2024, our sole insurance “Carrier” for: medical, pharmacy, vision, and dental is PacificSource, a local insurance company with national networks. (it used to be Regence & PacificSource, but now all PacificSource!)
For PDF of the benefits summary, click HERE.
Really into reading insurance benefits, and wish you could have more than the summaries? Click HERE for the full member handbook–COMING SOON!.
Glenn’s Summary of Benefits
Medical Benefits
Our insurance carrier PacificSource may be local, but they have access to a national network of providers, so rest easy: you are covered in Oregon and well beyond!
For Oregon, Washington, Idaho, and Montana, you can find out which medical provider here. In the “select plan or network” choose “Navigator.”
Outside of these four states, you can find in-network providers here. No need to select plan or network. Atnea ASA is a HUGE network and you should have no problems finding someone who takes your insurance at the in-network rates.
International coverage? You bet we have that on the plan! Basically, if you need “medically necessary, non-elective” medical services that would be covered here in the states, you can pay the local clinic, submit the claim electronically on your PacificSource account, and get reimbursed 90% of the visit/treatment! We also have emergency coverage beyond the basic things such as emergency evacuations and repatriations of remains (two common requirements when applying for a visa in another country).
You have a $100 deductible for medical services beginning September 16th of every year. This means starting every September 16th, you are responsible for paying the first $100 of medical charges you receive. Once you’ve met the deductible, you met it and do not have to pay it again until the next plan year. After meeting deducible, your medical services will be covered at 90% if you visit one of the hundreds of preferred providers from Regence, and 70% of the “maximum allowed” (the contracted in-network price) if you choose a non-preferred provider.
All medical services (excluding massage, PT, and acupuncture) are all free if rendered at the UO Health Center clinic. NOTE: the UOHC sends it’s lab samples to in-town lab for analysis so you will have to first meet $100 deductible (if not met) and then 10%. The blood draw itself would be free.
Our plan has a $2,200 out of pocket maximum for in-network services. i.e., get hit by a blimp and have $6M in bionic surgery, the most you will pay is $2,200, not 10% of $6M.
Dental Benefits
PacificSource is also our dental insurance carrier. GE’s have two dental plans offered by our insurance carrier:
the “PPO or Plus” plan and
the “EPO or Prepared” plan.
The EPO provides the most comprehensive coverage in terms of amount and services covered, e.g., it has orthodontia, but does limit service to in-network dentists in Oregon. Every time you go in you will pay a flat copay fee. Cleanings will be $25. There is no cap on coverage per year. There is NO out of state coverage under the EPO!
The PPO does allow a GE and dependents to see any dentist in the U.S., (but you will maximize payouts going in-network in Oregon) but has a $1,500 annual cap on coverage. You’ll pay 20% of minor things like fillings, teeth extractions, root canals and 40% of major things like a crown. Cleanings are free if you go to in-network dentist.
You can switch plans in the fall term under our dental “open enrollment” period.
Prescription Benefits
Prescriptions are covered at 70%. At major chain pharmacies all you need to do is show your insurance card and pay your 30% co-pay. The pharmacy will take care of billing Regence for the remaining charges. The 30% you end up paying counts towards your annual $2,200 out-of-pocket maximum. i.e., if you pay $2,200 in medical/prescription costs in one year, insurance will then pick up 100% of the medical/prescription bill after that.
Vision Benefits
You will pay $10 for an exam at in-network providers.
From there, it is pretty simple: you have $300 “pot of money” you can use for any vision hardware, at ANY provider! No network needed.
Mental Health (Behavioral, Counseling)
This is the#1 utilized service on our plan. Every. Year. No limit on number of sessions. No deductible to meet. You will pay 10% at in-network provider. Note: if you are doing remote (online/phone) sessions, your counselor does need to be licensed to practice in Oregon.
Physical, Occupational, and Speech Therapy, Massage, Chiropractic and Acupuncture–DEDUCTIBLE WAIVED!
Physical Therapy (PT), Occupational, Speech therapies: just like regular medical office visits, you have no limit and will pay 10% in-network. No deductible!
Massage: 40 visits covered per plan year (Sept 16th to Sept. 15th). You pay 10% NOTE: this is one of the non-free things at UO clinic. At UOHC you will still pay 10% just like in town.
Acupuncture: you have 20 visits per plan year (Sept 16th to Sept. 15th). Pay 10% in-network, no deductible!
Chiropractic: you have 25 visits per plan year (Sept 16th to Sept. 15th). Pay 10% in-network, no deductible!
For enrollment and benefits questions call Glenn Morris at 541-344-0832 or email benefits@gtff.net