MEDICAL Medical insurance helps you pay for preventive care, routine health needs, prescriptions, and advanced procedures by cost-sharing with your insurance provider. Hover over the insurance terms below to learn what they mean. Y O U R J O U R N E Y T O HEALTH REGENCE BLUECROSS BLUESHIELD OF OREGON: REGENCE CLASSIC IN-NETWORK OUT-OF-NETWORK DEDUCTIBLE Individual: $5,000 Family: $10,000 Individual: $10,000 Family: $20,000 COINSURANCE 20% coinsurance OFFICE VISITS Primary Care: $5 copay / first 3 upfront visits / year; $30 copay / office visit after 3 upfront visits; 20% coinsurance for all other services Specialist: $60 copay; 20% coinsurance for all other services Urgent Care: $60 copay; 20% coinsurance for all other services Primary Care: 40% coinsurance Specialist: 40% coinsurance Urgent Care: $60 copay; 40% coinsurance for all other services PROCEDURES Inpatient: 20% coinsurance Outpatient: 10% coinsurance for ambulatory surgery centers; 20% coinsurance for all other facilities Emergency Room: 20% coinsurance after $250 copay OP Lab & X-ray: 20% coinsurance Radiology: 20% coinsurance Inpatient: 40% coinsurance Outpatient: 40% coinsurance Emergency Room: 20% coinsurance after $250 copay OP Lab & X-ray: 40% coinsurance Radiology: 40% coinsurance PRESCRIPTIONS Retail: $10 / $50 / $75 / 50% coinsurance Mail Order: $20 / $100 / $150 / 50% coinsurance Retail: $10 / $50 / $75 / 50% coinsurance Mail Order: $20 / $100 / $150 / 50% coinsurance OUT-OF-POCKET MAXIMUM Individual: $8,000 Family: $16,000 Individual: $16,000 Family: $32,000 EMPLOYEE MONTHLY CONTRIBUTIONS Employee: $181.68 Employee + Spouse: $864.16 Employee + Child(ren): $678.04 Family: $1,360.51 *Deductible applies first. The benefits and rates in this guide are for illustrative purposes only. Please refer to the Summary of Benefits for specific benefits. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases. Review Plan SBC Regence Classic