UnitedHealthcare of Oregon, Inc. Cascade Gold

Health Insurance Plan Details (2024 Plan)

by UnitedHealthcare of Oregon, Inc.

Monthly Premium

EPO
$ubsidy
Gold
Deductible
$600 /yr
Max Out-of-Pocket
$6,100 /yr

Details

Deductible (per individual) $600 /yr
Deductible (per family) $1,200 /yr
Max Out-of-Pocket (per individual) $6,100 /yr
Max Out-of-Pocket (per family) $12,200 /yr
Drug Deductible (per individual)
Drug Deductible (per family)
Drug Max Out-of-Pocket (per individual)
Drug Max Out-of-Pocket (per family)
Plan Type EPO
Includes Child Dental? No
Includes Adult Dental? No
Medical Services
Preventive Care No Charge
Primary Care Visit $15 Copay
Specialist Visit $40 Copay
Emergency Room $450 Copay after deductible
Inpatient Facility $525 Copay per Day
Inpatient Physician Not Applicable
Drug Costs
Generic Drugs $10 Copay
Preferred Brand Drugs $60 Copay
Non-preferred Brand Drugs $100 Copay
Specialty Drugs $100 Copay

Plan Documents

Summary of Benefits and Coverage SBC doc
Provider Directory Doctor lookup
Drug Formulary List n/a

* Figures shown are only for in-network medical costs

** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible


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