Health Plan-Providence - Insurance Partners NW

Moda Select 2016 PlansCompared
COMPANY
Moda
Moda
Moda
Moda
Moda
Moda
Plan
BeProtected
BePrepared
StandardSilver
Be SupportedCCN
Standard
Bronze
BeLively
MetalTier
Gold
Silver
Silver
Silver
Bronze
(HASEligible)
Bronze
Deductible
$1,000
$1,550
$2,500
$2,500
$5,000
$5,500
Co-insurance
15%
30%
30%
35%
0%
40%
Maximum Out ofPocket (InNetwork)
$5,500
$6,850
$6,850
$6,500
$6,350
$6,850
PCP/Spec.copay
$15/$15
$30/$30
$35/$70
$30/$60
ded
$80
Urgent Carevisit
$15
$30
$90
$30
ded
$100
 
AlternativeCare
 
$15/$1000max
 
$30 visit/$1000max
 
na
 
na
 
na
 
40%
PrescriptionDrug
$2/$10/40%/50%
$2/$20/40%/50%
$15/$15/$50/50%
$2/$10/40%/50%
ded
$2/$10/ded/ded
Mental Healthvisit
$15
$30
$35
$30
ded
$80
Network
Beacon
Beacon
Beacon
CCN
Beacon
RoseCity
Non-Smoker, area 1rates
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
20 &Under
$183
$161
$152
$143
$125
$113
21
$289
$254
$240
$226
$197
$178
22
$289
$254
$240
$226
$197
$178
23
$289
$254
$240
$226
$197
$178
24
$289
$254
$240
$226
$197
$178
25
$290
$255
$241
$227
$198
$179
26
$296
$260
$246
$231
$201
$183
27
$302
$266
$251
$237
$206
$187
28
$314
$276
$261
$245
$214
$194
29
$323
$284
$269
$253
$220
$200
30
$328
$288
$272
$256
$223
$202
31
$334
$294
$278
$262
$228
$207

32
$341
$300
$284
$267
$223
$211
33
$346
$304
$287
$270
$236
$214
34
$350
$308
$291
$274
$239
$217
35
$353
$310
$293
$276
$240
$218
36
$355
$312
$295
$278
$242
$219
37
$357
$314
$297
$279
$244
$221
38
$360
$316
$299
$281
$245
$222
39
$364
$320
$303
$285
$248
$225
40
$369
$324
$307
$288
$251
$228
41
$376
$330
$312
$294
$256
$232
42
$382
$336
$318
$299
$261
$236
43
$392
$344
$326
$306
$267
$242
44
$403
$354
$335
$315
$275
$249
45
$417
$366
$347
$326
$284
$258
46
$433
$380
$360
$339
$295
$268
47
$451
$396
$375
$353
$308
$279
48
$472
$415
$392
$369
$322
$292
49
$492
$433
$409
$385
$336
$304
50
$515
$453
$429
$403
$351
$319
51
$538
$473
$448
$421
$367
$333
52
$563
$495
$468
$441
$384
$348
53
$589
$517
$490
$460
$401
$364
54
$616
$542
$512
$482
$420
$381
55
$644
$566
$535
$503
$439
$398
56
$673
$592
$560
$527
$459
$416
57
$703
$618
$585
$550
$480
$435
58
$735
$646
$611
$575
$501
$454
59
$751
$660
$625
$588
$512
$464
60
$783
$688
$651
$613
$534
$484
61
$811
$713
$674
$634
$553
$501
62
$829
$729
$689
$648
$565
$512
63
$852
$749
$708
$666
$581
$527
64
$866
$761
$720
$677
$590
$534

 
 
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