Required benefits

Plans sold after Jan. 1, 2014, must include benefits in 10 categories:

  • Ambulatory (outpatient) services 
  • Emergency services 
  • Hospitalization 
  • Maternity and newborn care 
  • Mental health and substance abuse disorder services, including behavioral health treatment 
  • Prescription drugs 
  • Rehabilitative and habilitative services and devices 
  • Laboratory services 
  • Preventive and wellness services and chronic disease management 
  • Pediatric services, including oral and vision care 

How can I tell how much a plan covers?

Plan labels will help you understand the level of coverage you are buying. The levels of coverage are:

  • Bronze - The plan covers 60 percent of expected costs for the average individual 
  • Silver - The plan covers 70 percent of expected costs for the average individual 
  • Gold - The plan covers 80 percent of expected costs for the average individual 
  • Platinum - The plan covers 90 percent of expected costs for the average individual 

What are catastrophic plans?

Catastrophic plans sold in Cover Oregon cover required benefits but do not have to cover at least 60 percent of estimated medical costs. They can have higher deductibles, meaning you pay more of the costs of medical care. These plans can be sold only to people younger than 30 and to others exempt from buying insurance because of financial hardship. 

Are there limits on my share of costs?

All plans sold or renewed in 2014 must limit your annual out-of-pocket costs (such as co-pays) to approximately $6,350 for an individual and $12,700 for families. These limits will be linked to average premium growth in future years. 

  • Lifetime coverage limits: Insurance companies cannot place a dollar limit on how much they will cover over your lifetime. 
  • Annual coverage limits: For plans sold or renewed on or after Jan. 1, 2014, federal law prohibits annual dollar limits on coverage of essential benefits. 




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