2019 KP Oregon Standard Bronze Plan Plan Details - HealthPocket

KP Oregon Standard Bronze Plan

$283.00/mo

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Zip Code97229
Applicant6/18/1984 Male
Coverage Start6/19/2019
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameKP Oregon Standard Bronze Plan
Plan IDhhs-71287OR0420004
Plan Year2019
Insurance ProviderKaiser Permanente
Metal LevelBronze
Plan TypeEPO
Deductible$6,550
Out-of-Pocket Maximum$6,550
Personal Score

Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness0.00% Coinsurance after deductible
Specialist Visit0.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services0.00% Coinsurance after deductible
X-rays and Diagnostic Imaging0.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans0.00% Coinsurance after deductible
Deductible - Family$13100 per group
Out-of-Pocket Maximum - Family$13100 per group

Prescription drug coverage

Generic Drugs0.00% Coinsurance after deductible
Preferred Brand Drugs0.00% Coinsurance after deductible
Non-Preferred Brand Drugs0.00% Coinsurance after deductible
Specialty Drugs0.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://healthy.kaiserpermanente.org/health/care/consumer/locate-our-services/doctors-and-locations
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.
Does this plan cover services outside plan service area?Yes - Dependent Out of Area; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions
Does this plan cover services outside the country?Yes - Emergency Only

Hospital services

Emergency Room Services0.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)0.00% Coinsurance after deductible
Inpatient Physician and Surgical Services0.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service0.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care0.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care0.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services0.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services0.00% Coinsurance after deductible
Substance use disorder outpatient services0.00% Coinsurance after deductible
Substance use disorder inpatient services0.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
Does this plan offer a wellness program?Included

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareNot Covered
Child Dental Coverage - Basic Dental CareNot Covered
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareNot Covered

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Cosmetic Surgery
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Durable Medical Equipment
Hospice Services
Routine Foot Care
Inherited Metabolic Disorder - PKU
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Well Baby Visits and Care
Brain Injury
Clinical Trials
Off Label Prescription Drugs
Prescription Drugs Other
Mastectomy-Related Coverage
More Limited BenefitsSkilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Rehabilitative Occupational Therapy
Rehabilitative Physical Therapy
More Excluded BenefitsAcupuncture
Bariatric Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Chiropractic Care
Non-Emergency Care When Traveling Outside the U.S.
Treatment for Temporomandibular Joint Disorders
PremiumPlan NameDeductible
from $248
PacificSource Oregon Standard Bronze Plan LHN
$6,550.00Select
from $250
KP Oregon Standard Bronze Plan
$6,550.00Select
from $251
KP OR Bronze 6550/0% HSA
$6,550.00Select
from $252
Legacy Bronze HSA 6650
$6,650.00Select
from $259
PacificSource Oregon Standard Bronze Plan SCN
$6,550.00Select
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Journey To Health Physical Therapy And Wellness Clinic, Llc
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Marilyn Webber, M.D.
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  • Phone Number
    (503) 629-0237
  • Office Locations
    14223 Nw Spruceridge Ln
    Portland, OR 97229
14223 Nw Spruceridge Ln Portland OR, 97229
  • What is a bronze plan?

    Bronze Plan is a type of Metal Plan on the Health Insurance Marketplace. Bronze Plans qualify for Tax Credits and have low premiums. Generally speaking, a Bronze Plan is intended to have the lowest premium of the 4 new categories of health plans under the Affordable Care Act but charge the highest out-of-pocket costs for healthcare services.

  • How are Bronze Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Bronze Plan pays 60% of the covered medical costs among its enrollees while the other Obamacare health plans pay a higher percentage of these costs.

  • How much does a Bronze Plan cost?

    The monthly premium for a Bronze Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Bronze Plan premiums in your area. Another important factor to remember is Advanced Premium Tax Credits which can subsidize bronze plan premiums if an individual meets eligibility criteria.

  • When Can I Enroll in a Bronze Plan?

    The annual enrollment period for the 2018 plan year will begin on November 1, 2017 and continue through December 15, 2017.

    In 2015 there had been a Special Enrollment Period for many facing the uninsured penalty on their 2014 tax return. There is no guarantee that a similar Special Enrollment Period will be granted in 2017. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)