MEDICAL Y O U R J O U R N E Y T O HEALTH Medical insurance helps you pay for preven琀椀ve care, rou琀椀ne health needs, prescrip琀椀ons, and advanced procedures by cost-sharing with your insurance provider. Hover over the insurance terms below to learn what they mean. REGENCE BLUECROSS BLUESHIELD OF OREGON: REGENCE CLASSIC IN-NETWORK OUT-OF-NETWORK DEDUCTIBLE Individual: $5,000 Individual: $10,000 Family: $10,000 Family: $20,000 COINSURANCE 20% coinsurance Review Primary Care: $5 copay / 昀椀rst 3 upfront visits / year; $30 copay / o昀케ce visit Plan SBC Primary Care: 40% coinsurance OFFICE VISITS a昀琀er 3 upfront visits; 20% coinsurance for all other services Specialist: 40% coinsurance Specialist: $60 copay; 20% coinsurance for all other services Urgent Care: $60 copay; 40% coinsurance for all other services Urgent Care: $60 copay; 20% coinsurance for all other services Inpa琀椀ent: 20% coinsurance Regence Outpa琀椀ent: 10% coinsurance for ambulatory surgery centers; Inpa琀椀ent: 40% coinsurance Classic Outpa琀椀ent: 40% coinsurance PROCEDURES 20% coinsurance for all other facili琀椀es Emergency Room: 20% coinsurance a昀琀er $250 copay Emergency Room: 20% coinsurance a昀琀er $250 copay OP Lab & X-ray: 40% coinsurance OP Lab & X-ray: 20% coinsurance Radiology: 40% coinsurance Radiology: 20% coinsurance PRESCRIPTIONS Retail: $10 / $50 / $75 / 50% coinsurance Retail: $10 / $50 / $75 / 50% coinsurance Mail Order: $20 / $100 / $150 / 50% coinsurance Mail Order: $20 / $100 / $150 / 50% coinsurance OUT-OF-POCKET Individual: $8,000 Individual: $16,000 MAXIMUM Family: $16,000 Family: $32,000 EMPLOYEE Employee: $181.68 MONTHLY Employee + Spouse: $864.16 CONTRIBUTIONS Employee + Child(ren): $678.04 Family: $1,360.51 *Deduc琀椀ble applies 昀椀rst. The bene昀椀ts and rates in this guide are for illustra琀椀ve purposes only. Please refer to the Summary of Bene昀椀ts for speci昀椀c bene昀椀ts. To the extent the rates or the bene昀椀t plan informa琀椀on summarized herein di昀昀ers from the underlying plan details speci昀椀ed in the insurance documents that govern the terms and condi琀椀ons of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases.