Obamacare 2021 Rates for Clackamas County

Obamacare > Rates > Oregon > Clackamas County

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Clackamas County, OR.

The health insurance rates listed below are for calendar year 2021.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 69 Plans and 2021 Rates for Clackamas County, Oregon

Below, you’ll find a summary of the 69 plans for Clackamas County, Oregon and rates for each of these providers. This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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PacificSource Health Plans

Local: 1-541-684-5582 | Toll Free: 1-888-977-9299 | TTY: 1-800-735-2900

Toc - Plan #1 PacificSource Health Plans
Catastrophic

(PPO) Navigator Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$185,00
$210,00
$237,00
$331,00
$503,00
$303,00
$328,00
$355,00
$449,00
$421,00
$446,00
$473,00
$567,00
$539,00
$564,00
$591,00
$685,00
$118,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$370,00
$420,00
$474,00
$662,00
$1 006,00
$488,00
$538,00
$592,00
$780,00
$606,00
$656,00
$710,00
$898,00
$724,00
$774,00
$828,00
$1 016,00
$118,00
Toc - Plan #2 PacificSource Health Plans
Expanded Bronze

(PPO) PacificSource Oregon Standard Bronze Plan NAV

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$274,00
$311,00
$350,00
$490,00
$744,00
$448,00
$485,00
$524,00
$664,00
$622,00
$659,00
$698,00
$838,00
$796,00
$833,00
$872,00
$1 012,00
$174,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$548,00
$622,00
$700,00
$980,00
$1 488,00
$722,00
$796,00
$874,00
$1 154,00
$896,00
$970,00
$1 048,00
$1 328,00
$1 070,00
$1 144,00
$1 222,00
$1 502,00
$174,00
Toc - Plan #3 PacificSource Health Plans
Silver

(PPO) PacificSource Oregon Standard Silver Plan NAV

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$360,00
$408,00
$460,00
$642,00
$976,00
$588,00
$636,00
$688,00
$870,00
$816,00
$864,00
$916,00
$1 098,00
$1 044,00
$1 092,00
$1 144,00
$1 326,00
$228,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$720,00
$816,00
$920,00
$1 284,00
$1 952,00
$948,00
$1 044,00
$1 148,00
$1 512,00
$1 176,00
$1 272,00
$1 376,00
$1 740,00
$1 404,00
$1 500,00
$1 604,00
$1 968,00
$228,00
Toc - Plan #4 PacificSource Health Plans
Gold

(PPO) PacificSource Oregon Standard Gold Plan NAV

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$399,00
$453,00
$510,00
$713,00
$1 083,00
$652,00
$706,00
$763,00
$966,00
$905,00
$959,00
$1 016,00
$1 219,00
$1 158,00
$1 212,00
$1 269,00
$1 472,00
$253,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$798,00
$906,00
$1 020,00
$1 426,00
$2 166,00
$1 051,00
$1 159,00
$1 273,00
$1 679,00
$1 304,00
$1 412,00
$1 526,00
$1 932,00
$1 557,00
$1 665,00
$1 779,00
$2 185,00
$253,00
Toc - Plan #5 PacificSource Health Plans
Expanded Bronze

(PPO) Navigator Bronze HSA 6900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$277,00
$315,00
$355,00
$496,00
$753,00
$453,00
$491,00
$531,00
$672,00
$629,00
$667,00
$707,00
$848,00
$805,00
$843,00
$883,00
$1 024,00
$176,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$554,00
$630,00
$710,00
$992,00
$1 506,00
$730,00
$806,00
$886,00
$1 168,00
$906,00
$982,00
$1 062,00
$1 344,00
$1 082,00
$1 158,00
$1 238,00
$1 520,00
$176,00
Toc - Plan #6 PacificSource Health Plans
Expanded Bronze

(PPO) Navigator Bronze 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$281,00
$319,00
$360,00
$503,00
$764,00
$460,00
$498,00
$539,00
$682,00
$639,00
$677,00
$718,00
$861,00
$818,00
$856,00
$897,00
$1 040,00
$179,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$562,00
$638,00
$720,00
$1 006,00
$1 528,00
$741,00
$817,00
$899,00
$1 185,00
$920,00
$996,00
$1 078,00
$1 364,00
$1 099,00
$1 175,00
$1 257,00
$1 543,00
$179,00
Toc - Plan #7 PacificSource Health Plans
Silver

(PPO) Navigator Silver 4000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$363,00
$412,00
$464,00
$649,00
$986,00
$594,00
$643,00
$695,00
$880,00
$825,00
$874,00
$926,00
$1 111,00
$1 056,00
$1 105,00
$1 157,00
$1 342,00
$231,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$726,00
$824,00
$928,00
$1 298,00
$1 972,00
$957,00
$1 055,00
$1 159,00
$1 529,00
$1 188,00
$1 286,00
$1 390,00
$1 760,00
$1 419,00
$1 517,00
$1 621,00
$1 991,00
$231,00
Toc - Plan #8 PacificSource Health Plans
Silver

(PPO) Navigator Silver 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$375,00
$426,00
$479,00
$670,00
$1 018,00
$613,00
$664,00
$717,00
$908,00
$851,00
$902,00
$955,00
$1 146,00
$1 089,00
$1 140,00
$1 193,00
$1 384,00
$238,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$750,00
$852,00
$958,00
$1 340,00
$2 036,00
$988,00
$1 090,00
$1 196,00
$1 578,00
$1 226,00
$1 328,00
$1 434,00
$1 816,00
$1 464,00
$1 566,00
$1 672,00
$2 054,00
$238,00
Toc - Plan #9 PacificSource Health Plans
Gold

(PPO) Navigator Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-977-9299

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$410,00
$466,00
$524,00
$733,00
$1 114,00
$671,00
$727,00
$785,00
$994,00
$932,00
$988,00
$1 046,00
$1 255,00
$1 193,00
$1 249,00
$1 307,00
$1 516,00
$261,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$820,00
$932,00
$1 048,00
$1 466,00
$2 228,00
$1 081,00
$1 193,00
$1 309,00
$1 727,00
$1 342,00
$1 454,00
$1 570,00
$1 988,00
$1 603,00
$1 715,00
$1 831,00
$2 249,00
$261,00

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Moda Health Plan, Inc.

Local: 1-888-393-2940 | Toll Free: 1-888-393-2940 | TTY: 1-888-393-2940

Toc - Plan #10 Moda Health Plan, Inc.
Gold

(EPO) Moda Health Beacon Gold 1000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$399,00
$453,00
$510,00
$713,00
$1 084,00
$653,00
$707,00
$764,00
$967,00
$907,00
$961,00
$1 018,00
$1 221,00
$1 161,00
$1 215,00
$1 272,00
$1 475,00
$254,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$798,00
$906,00
$1 020,00
$1 426,00
$2 168,00
$1 052,00
$1 160,00
$1 274,00
$1 680,00
$1 306,00
$1 414,00
$1 528,00
$1 934,00
$1 560,00
$1 668,00
$1 782,00
$2 188,00
$254,00
Toc - Plan #11 Moda Health Plan, Inc.
Silver

(EPO) Moda Health Beacon Silver 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$351,00
$398,00
$449,00
$627,00
$953,00
$574,00
$621,00
$672,00
$850,00
$797,00
$844,00
$895,00
$1 073,00
$1 020,00
$1 067,00
$1 118,00
$1 296,00
$223,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$702,00
$796,00
$898,00
$1 254,00
$1 906,00
$925,00
$1 019,00
$1 121,00
$1 477,00
$1 148,00
$1 242,00
$1 344,00
$1 700,00
$1 371,00
$1 465,00
$1 567,00
$1 923,00
$223,00
Toc - Plan #12 Moda Health Plan, Inc.
Gold

(EPO) Moda Health Oregon Standard Gold (Beacon)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$395,00
$449,00
$505,00
$706,00
$1 073,00
$646,00
$700,00
$756,00
$957,00
$897,00
$951,00
$1 007,00
$1 208,00
$1 148,00
$1 202,00
$1 258,00
$1 459,00
$251,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$790,00
$898,00
$1 010,00
$1 412,00
$2 146,00
$1 041,00
$1 149,00
$1 261,00
$1 663,00
$1 292,00
$1 400,00
$1 512,00
$1 914,00
$1 543,00
$1 651,00
$1 763,00
$2 165,00
$251,00
Toc - Plan #13 Moda Health Plan, Inc.
Silver

(EPO) Moda Health Oregon Standard Silver (Beacon)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$346,00
$392,00
$442,00
$617,00
$938,00
$566,00
$612,00
$662,00
$837,00
$786,00
$832,00
$882,00
$1 057,00
$1 006,00
$1 052,00
$1 102,00
$1 277,00
$220,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$692,00
$784,00
$884,00
$1 234,00
$1 876,00
$912,00
$1 004,00
$1 104,00
$1 454,00
$1 132,00
$1 224,00
$1 324,00
$1 674,00
$1 352,00
$1 444,00
$1 544,00
$1 894,00
$220,00
Toc - Plan #14 Moda Health Plan, Inc.
Expanded Bronze

(EPO) Moda Health Oregon Standard Bronze Plan (Beacon)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$265,00
$300,00
$338,00
$473,00
$718,00
$433,00
$468,00
$506,00
$641,00
$601,00
$636,00
$674,00
$809,00
$769,00
$804,00
$842,00
$977,00
$168,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$530,00
$600,00
$676,00
$946,00
$1 436,00
$698,00
$768,00
$844,00
$1 114,00
$866,00
$936,00
$1 012,00
$1 282,00
$1 034,00
$1 104,00
$1 180,00
$1 450,00
$168,00
Toc - Plan #15 Moda Health Plan, Inc.
Gold

(EPO) Moda Health Beacon Gold 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$381,00
$433,00
$487,00
$681,00
$1 035,00
$623,00
$675,00
$729,00
$923,00
$865,00
$917,00
$971,00
$1 165,00
$1 107,00
$1 159,00
$1 213,00
$1 407,00
$242,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$762,00
$866,00
$974,00
$1 362,00
$2 070,00
$1 004,00
$1 108,00
$1 216,00
$1 604,00
$1 246,00
$1 350,00
$1 458,00
$1 846,00
$1 488,00
$1 592,00
$1 700,00
$2 088,00
$242,00
Toc - Plan #16 Moda Health Plan, Inc.
Silver

(EPO) Moda Health Beacon Silver 3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$327,00
$371,00
$418,00
$584,00
$888,00
$535,00
$579,00
$626,00
$792,00
$743,00
$787,00
$834,00
$1 000,00
$951,00
$995,00
$1 042,00
$1 208,00
$208,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$654,00
$742,00
$836,00
$1 168,00
$1 776,00
$862,00
$950,00
$1 044,00
$1 376,00
$1 070,00
$1 158,00
$1 252,00
$1 584,00
$1 278,00
$1 366,00
$1 460,00
$1 792,00
$208,00
Toc - Plan #17 Moda Health Plan, Inc.
Expanded Bronze

(EPO) Moda Health Beacon Bronze HSA 6900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$283,00
$322,00
$362,00
$506,00
$769,00
$463,00
$502,00
$542,00
$686,00
$643,00
$682,00
$722,00
$866,00
$823,00
$862,00
$902,00
$1 046,00
$180,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$566,00
$644,00
$724,00
$1 012,00
$1 538,00
$746,00
$824,00
$904,00
$1 192,00
$926,00
$1 004,00
$1 084,00
$1 372,00
$1 106,00
$1 184,00
$1 264,00
$1 552,00
$180,00
Toc - Plan #18 Moda Health Plan, Inc.
Expanded Bronze

(EPO) Moda Health Beacon Bronze 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$267,00
$303,00
$341,00
$477,00
$724,00
$437,00
$473,00
$511,00
$647,00
$607,00
$643,00
$681,00
$817,00
$777,00
$813,00
$851,00
$987,00
$170,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$534,00
$606,00
$682,00
$954,00
$1 448,00
$704,00
$776,00
$852,00
$1 124,00
$874,00
$946,00
$1 022,00
$1 294,00
$1 044,00
$1 116,00
$1 192,00
$1 464,00
$170,00
Toc - Plan #19 Moda Health Plan, Inc.
Gold

(EPO) Moda Health Beacon Gold 250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-393-2940

Annual Out of Pocket Expenses:

Individual Family
$250 $500 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$399,00
$453,00
$510,00
$713,00
$1 083,00
$652,00
$706,00
$763,00
$966,00
$905,00
$959,00
$1 016,00
$1 219,00
$1 158,00
$1 212,00
$1 269,00
$1 472,00
$253,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$798,00
$906,00
$1 020,00
$1 426,00
$2 166,00
$1 051,00
$1 159,00
$1 273,00
$1 679,00
$1 304,00
$1 412,00
$1 526,00
$1 932,00
$1 557,00
$1 665,00
$1 779,00
$2 185,00
$253,00

ADVERTISEMENT

Providence Health Plan

Local: 1-503-574-5000 | Toll Free: 1-800-878-4445 | TTY: 1-888-244-6642

Toc - Plan #20 Providence Health Plan
Gold

(EPO) Providence Oregon Standard Gold Plan - Choice Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$398,00
$452,00
$509,00
$712,00
$1 081,00
$651,00
$705,00
$762,00
$965,00
$904,00
$958,00
$1 015,00
$1 218,00
$1 157,00
$1 211,00
$1 268,00
$1 471,00
$253,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$796,00
$904,00
$1 018,00
$1 424,00
$2 162,00
$1 049,00
$1 157,00
$1 271,00
$1 677,00
$1 302,00
$1 410,00
$1 524,00
$1 930,00
$1 555,00
$1 663,00
$1 777,00
$2 183,00
$253,00
Toc - Plan #21 Providence Health Plan
Silver

(EPO) Providence Oregon Standard Silver Plan - Choice Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$351,00
$399,00
$449,00
$628,00
$954,00
$574,00
$622,00
$672,00
$851,00
$797,00
$845,00
$895,00
$1 074,00
$1 020,00
$1 068,00
$1 118,00
$1 297,00
$223,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$702,00
$798,00
$898,00
$1 256,00
$1 908,00
$925,00
$1 021,00
$1 121,00
$1 479,00
$1 148,00
$1 244,00
$1 344,00
$1 702,00
$1 371,00
$1 467,00
$1 567,00
$1 925,00
$223,00
Toc - Plan #22 Providence Health Plan
Gold

(EPO) Connect 1500 Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$8,200 $16,400 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$346,00
$393,00
$442,00
$618,00
$939,00
$566,00
$613,00
$662,00
$838,00
$786,00
$833,00
$882,00
$1 058,00
$1 006,00
$1 053,00
$1 102,00
$1 278,00
$220,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$692,00
$786,00
$884,00
$1 236,00
$1 878,00
$912,00
$1 006,00
$1 104,00
$1 456,00
$1 132,00
$1 226,00
$1 324,00
$1 676,00
$1 352,00
$1 446,00
$1 544,00
$1 896,00
$220,00
Toc - Plan #23 Providence Health Plan
Silver

(EPO) Connect 4500 Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$314,00
$357,00
$402,00
$562,00
$853,00
$514,00
$557,00
$602,00
$762,00
$714,00
$757,00
$802,00
$962,00
$914,00
$957,00
$1 002,00
$1 162,00
$200,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$628,00
$714,00
$804,00
$1 124,00
$1 706,00
$828,00
$914,00
$1 004,00
$1 324,00
$1 028,00
$1 114,00
$1 204,00
$1 524,00
$1 228,00
$1 314,00
$1 404,00
$1 724,00
$200,00
Toc - Plan #24 Providence Health Plan
Expanded Bronze

(EPO) Connect 8550 Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$241,00
$274,00
$309,00
$431,00
$655,00
$394,00
$427,00
$462,00
$584,00
$547,00
$580,00
$615,00
$737,00
$700,00
$733,00
$768,00
$890,00
$153,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$482,00
$548,00
$618,00
$862,00
$1 310,00
$635,00
$701,00
$771,00
$1 015,00
$788,00
$854,00
$924,00
$1 168,00
$941,00
$1 007,00
$1 077,00
$1 321,00
$153,00
Toc - Plan #25 Providence Health Plan
Expanded Bronze

(EPO) Providence Oregon Standard Bronze Plan - Choice Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$275,00
$312,00
$352,00
$491,00
$747,00
$450,00
$487,00
$527,00
$666,00
$625,00
$662,00
$702,00
$841,00
$800,00
$837,00
$877,00
$1 016,00
$175,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$550,00
$624,00
$704,00
$982,00
$1 494,00
$725,00
$799,00
$879,00
$1 157,00
$900,00
$974,00
$1 054,00
$1 332,00
$1 075,00
$1 149,00
$1 229,00
$1 507,00
$175,00
Toc - Plan #26 Providence Health Plan
Expanded Bronze

(EPO) HSA Qualified 7000 Bronze - Choice Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-878-4445

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$277,00
$314,00
$354,00
$494,00
$751,00
$453,00
$490,00
$530,00
$670,00
$629,00
$666,00
$706,00
$846,00
$805,00
$842,00
$882,00
$1 022,00
$176,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$554,00
$628,00
$708,00
$988,00
$1 502,00
$730,00
$804,00
$884,00
$1 164,00
$906,00
$980,00
$1 060,00
$1 340,00
$1 082,00
$1 156,00
$1 236,00
$1 516,00
$176,00

ADVERTISEMENT

BridgeSpan Health Company

Local: 1-855-857-9943 | Toll Free: 1-855-857-9943 | TTY: 1-800-735-2900

Toc - Plan #27 BridgeSpan Health Company
Gold

(EPO) BridgeSpan Standard Gold Plan EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9943

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$429,37
$487,34
$548,74
$766,86
$1 165,31
$702,02
$759,99
$821,39
$1 039,51
$974,67
$1 032,64
$1 094,04
$1 312,16
$1 247,32
$1 305,29
$1 366,69
$1 584,81
$272,65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$858,74
$974,68
$1 097,48
$1 533,72
$2 330,62
$1 131,39
$1 247,33
$1 370,13
$1 806,37
$1 404,04
$1 519,98
$1 642,78
$2 079,02
$1 676,69
$1 792,63
$1 915,43
$2 351,67
$272,65
Toc - Plan #28 BridgeSpan Health Company
Silver

(EPO) BridgeSpan Standard Silver Plan EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9943

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$372,23
$422,48
$475,70
$664,80
$1 010,22
$608,59
$658,84
$712,06
$901,16
$844,95
$895,20
$948,42
$1 137,52
$1 081,31
$1 131,56
$1 184,78
$1 373,88
$236,36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$744,46
$844,96
$951,40
$1 329,60
$2 020,44
$980,82
$1 081,32
$1 187,76
$1 565,96
$1 217,18
$1 317,68
$1 424,12
$1 802,32
$1 453,54
$1 554,04
$1 660,48
$2 038,68
$236,36
Toc - Plan #29 BridgeSpan Health Company
Expanded Bronze

(EPO) BridgeSpan Standard Bronze Plan EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9943

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$270,48
$306,99
$345,67
$483,07
$734,08
$442,23
$478,74
$517,42
$654,82
$613,98
$650,49
$689,17
$826,57
$785,73
$822,24
$860,92
$998,32
$171,75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$540,96
$613,98
$691,34
$966,14
$1 468,16
$712,71
$785,73
$863,09
$1 137,89
$884,46
$957,48
$1 034,84
$1 309,64
$1 056,21
$1 129,23
$1 206,59
$1 481,39
$171,75
Toc - Plan #30 BridgeSpan Health Company
Gold

(EPO) BridgeSpan Standard Gold Plan EPO RealValue

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9943

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$442,65
$502,40
$565,70
$790,57
$1 201,35
$723,73
$783,48
$846,78
$1 071,65
$1 004,81
$1 064,56
$1 127,86
$1 352,73
$1 285,89
$1 345,64
$1 408,94
$1 633,81
$281,08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$885,30
$1 004,80
$1 131,40
$1 581,14
$2 402,70
$1 166,38
$1 285,88
$1 412,48
$1 862,22
$1 447,46
$1 566,96
$1 693,56
$2 143,30
$1 728,54
$1 848,04
$1 974,64
$2 424,38
$281,08
Toc - Plan #31 BridgeSpan Health Company
Expanded Bronze

(EPO) BridgeSpan Standard Bronze Plan EPO RealValue

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9943

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$278,81
$316,45
$356,32
$497,96
$756,70
$455,86
$493,50
$533,37
$675,01
$632,91
$670,55
$710,42
$852,06
$809,96
$847,60
$887,47
$1 029,11
$177,05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$557,62
$632,90
$712,64
$995,92
$1 513,40
$734,67
$809,95
$889,69
$1 172,97
$911,72
$987,00
$1 066,74
$1 350,02
$1 088,77
$1 164,05
$1 243,79
$1 527,07
$177,05
Toc - Plan #32 BridgeSpan Health Company
Silver

(EPO) BridgeSpan Standard Silver Plan EPO RealValue

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9943

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$383,73
$435,53
$490,40
$685,34
$1 041,43
$627,40
$679,20
$734,07
$929,01
$871,07
$922,87
$977,74
$1 172,68
$1 114,74
$1 166,54
$1 221,41
$1 416,35
$243,67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$767,46
$871,06
$980,80
$1 370,68
$2 082,86
$1 011,13
$1 114,73
$1 224,47
$1 614,35
$1 254,80
$1 358,40
$1 468,14
$1 858,02
$1 498,47
$1 602,07
$1 711,81
$2 101,69
$243,67
Toc - Plan #33 BridgeSpan Health Company
Gold

(EPO) BridgeSpan Standard Gold Plan EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9943

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$420,52
$477,29
$537,42
$751,04
$1 141,28
$687,55
$744,32
$804,45
$1 018,07
$954,58
$1 011,35
$1 071,48
$1 285,10
$1 221,61
$1 278,38
$1 338,51
$1 552,13
$267,03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$841,04
$954,58
$1 074,84
$1 502,08
$2 282,56
$1 108,07
$1 221,61
$1 341,87
$1 769,11
$1 375,10
$1 488,64
$1 608,90
$2 036,14
$1 642,13
$1 755,67
$1 875,93
$2 303,17
$267,03
Toc - Plan #34 BridgeSpan Health Company
Silver

(EPO) BridgeSpan Standard Silver Plan EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9943

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$364,52
$413,74
$465,86
$651,04
$989,32
$595,99
$645,21
$697,33
$882,51
$827,46
$876,68
$928,80
$1 113,98
$1 058,93
$1 108,15
$1 160,27
$1 345,45
$231,47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$729,04
$827,48
$931,72
$1 302,08
$1 978,64
$960,51
$1 058,95
$1 163,19
$1 533,55
$1 191,98
$1 290,42
$1 394,66
$1 765,02
$1 423,45
$1 521,89
$1 626,13
$1 996,49
$231,47
Toc - Plan #35 BridgeSpan Health Company
Expanded Bronze

(EPO) BridgeSpan Standard Bronze Plan EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-857-9943

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$264,90
$300,66
$338,55
$473,12
$718,95
$433,11
$468,87
$506,76
$641,33
$601,32
$637,08
$674,97
$809,54
$769,53
$805,29
$843,18
$977,75
$168,21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$529,80
$601,32
$677,10
$946,24
$1 437,90
$698,01
$769,53
$845,31
$1 114,45
$866,22
$937,74
$1 013,52
$1 282,66
$1 034,43
$1 105,95
$1 181,73
$1 450,87
$168,21

ADVERTISEMENT

Kaiser Permanente

Local: 1-800-801-1270 | Toll Free: 1-800-801-1270 | TTY: 1-800-735-2900

Toc - Plan #36 Kaiser Permanente
Gold

(EPO) KP OR Gold 0/20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$351,00
$398,00
$448,00
$626,00
$952,00
$574,00
$621,00
$671,00
$849,00
$797,00
$844,00
$894,00
$1 072,00
$1 020,00
$1 067,00
$1 117,00
$1 295,00
$223,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$702,00
$796,00
$896,00
$1 252,00
$1 904,00
$925,00
$1 019,00
$1 119,00
$1 475,00
$1 148,00
$1 242,00
$1 342,00
$1 698,00
$1 371,00
$1 465,00
$1 565,00
$1 921,00
$223,00
Toc - Plan #37 Kaiser Permanente
Gold

(EPO) KP Oregon Standard Gold Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$344,00
$391,00
$440,00
$615,00
$934,00
$563,00
$610,00
$659,00
$834,00
$782,00
$829,00
$878,00
$1 053,00
$1 001,00
$1 048,00
$1 097,00
$1 272,00
$219,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$688,00
$782,00
$880,00
$1 230,00
$1 868,00
$907,00
$1 001,00
$1 099,00
$1 449,00
$1 126,00
$1 220,00
$1 318,00
$1 668,00
$1 345,00
$1 439,00
$1 537,00
$1 887,00
$219,00
Toc - Plan #38 Kaiser Permanente
Silver

(EPO) KP Oregon Standard Silver Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$333,00
$378,00
$425,00
$594,00
$903,00
$544,00
$589,00
$636,00
$805,00
$755,00
$800,00
$847,00
$1 016,00
$966,00
$1 011,00
$1 058,00
$1 227,00
$211,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$666,00
$756,00
$850,00
$1 188,00
$1 806,00
$877,00
$967,00
$1 061,00
$1 399,00
$1 088,00
$1 178,00
$1 272,00
$1 610,00
$1 299,00
$1 389,00
$1 483,00
$1 821,00
$211,00
Toc - Plan #39 Kaiser Permanente
Expanded Bronze

(EPO) KP Oregon Standard Bronze Plan

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$239,00
$271,00
$305,00
$426,00
$648,00
$391,00
$423,00
$457,00
$578,00
$543,00
$575,00
$609,00
$730,00
$695,00
$727,00
$761,00
$882,00
$152,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$478,00
$542,00
$610,00
$852,00
$1 296,00
$630,00
$694,00
$762,00
$1 004,00
$782,00
$846,00
$914,00
$1 156,00
$934,00
$998,00
$1 066,00
$1 308,00
$152,00
Toc - Plan #40 Kaiser Permanente
Gold

(EPO) KP OR Gold 1500/30

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$326,00
$370,00
$417,00
$582,00
$885,00
$533,00
$577,00
$624,00
$789,00
$740,00
$784,00
$831,00
$996,00
$947,00
$991,00
$1 038,00
$1 203,00
$207,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$652,00
$740,00
$834,00
$1 164,00
$1 770,00
$859,00
$947,00
$1 041,00
$1 371,00
$1 066,00
$1 154,00
$1 248,00
$1 578,00
$1 273,00
$1 361,00
$1 455,00
$1 785,00
$207,00
Toc - Plan #41 Kaiser Permanente
Silver

(EPO) KP OR Silver 2500/40

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$344,00
$391,00
$440,00
$615,00
$935,00
$563,00
$610,00
$659,00
$834,00
$782,00
$829,00
$878,00
$1 053,00
$1 001,00
$1 048,00
$1 097,00
$1 272,00
$219,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$688,00
$782,00
$880,00
$1 230,00
$1 870,00
$907,00
$1 001,00
$1 099,00
$1 449,00
$1 126,00
$1 220,00
$1 318,00
$1 668,00
$1 345,00
$1 439,00
$1 537,00
$1 887,00
$219,00
Toc - Plan #42 Kaiser Permanente
Silver

(EPO) KP OR Silver 4500/40

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$317,00
$360,00
$406,00
$567,00
$861,00
$519,00
$562,00
$608,00
$769,00
$721,00
$764,00
$810,00
$971,00
$923,00
$966,00
$1 012,00
$1 173,00
$202,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$634,00
$720,00
$812,00
$1 134,00
$1 722,00
$836,00
$922,00
$1 014,00
$1 336,00
$1 038,00
$1 124,00
$1 216,00
$1 538,00
$1 240,00
$1 326,00
$1 418,00
$1 740,00
$202,00
Toc - Plan #43 Kaiser Permanente
Expanded Bronze

(EPO) KP OR Bronze 5500/50

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$242,00
$275,00
$310,00
$433,00
$657,00
$396,00
$429,00
$464,00
$587,00
$550,00
$583,00
$618,00
$741,00
$704,00
$737,00
$772,00
$895,00
$154,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$484,00
$550,00
$620,00
$866,00
$1 314,00
$638,00
$704,00
$774,00
$1 020,00
$792,00
$858,00
$928,00
$1 174,00
$946,00
$1 012,00
$1 082,00
$1 328,00
$154,00
Toc - Plan #44 Kaiser Permanente
Expanded Bronze

(EPO) KP OR Bronze 6900/0% HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$240,00
$272,00
$306,00
$428,00
$650,00
$392,00
$424,00
$458,00
$580,00
$544,00
$576,00
$610,00
$732,00
$696,00
$728,00
$762,00
$884,00
$152,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$480,00
$544,00
$612,00
$856,00
$1 300,00
$632,00
$696,00
$764,00
$1 008,00
$784,00
$848,00
$916,00
$1 160,00
$936,00
$1 000,00
$1 068,00
$1 312,00
$152,00
Toc - Plan #45 Kaiser Permanente
Expanded Bronze

(EPO) KP OR Bronze 8550/75

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-801-1270

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$233,00
$265,00
$298,00
$416,00
$633,00
$381,00
$413,00
$446,00
$564,00
$529,00
$561,00
$594,00
$712,00
$677,00
$709,00
$742,00
$860,00
$148,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$466,00
$530,00
$596,00
$832,00
$1 266,00
$614,00
$678,00
$744,00
$980,00
$762,00
$826,00
$892,00
$1 128,00
$910,00
$974,00
$1 040,00
$1 276,00
$148,00

ADVERTISEMENT

Regence BlueCross BlueShield of Oregon

Local: 1-888-675-6570 | Toll Free: 1-888-675-6570

Toc - Plan #46 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Bronze HDHP 5700 EPO Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$270,98
$307,56
$346,31
$483,97
$735,44
$443,05
$479,63
$518,38
$656,04
$615,12
$651,70
$690,45
$828,11
$787,19
$823,77
$862,52
$1 000,18
$172,07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$541,96
$615,12
$692,62
$967,94
$1 470,88
$714,03
$787,19
$864,69
$1 140,01
$886,10
$959,26
$1 036,76
$1 312,08
$1 058,17
$1 131,33
$1 208,83
$1 484,15
$172,07
Toc - Plan #47 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Bronze HDHP 5700 EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$262,86
$298,35
$335,94
$469,47
$713,41
$429,78
$465,27
$502,86
$636,39
$596,70
$632,19
$669,78
$803,31
$763,62
$799,11
$836,70
$970,23
$166,92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$525,72
$596,70
$671,88
$938,94
$1 426,82
$692,64
$763,62
$838,80
$1 105,86
$859,56
$930,54
$1 005,72
$1 272,78
$1 026,48
$1 097,46
$1 172,64
$1 439,70
$166,92
Toc - Plan #48 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Silver 3500 EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$344,26
$390,74
$439,97
$614,85
$934,33
$562,87
$609,35
$658,58
$833,46
$781,48
$827,96
$877,19
$1 052,07
$1 000,09
$1 046,57
$1 095,80
$1 270,68
$218,61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$688,52
$781,48
$879,94
$1 229,70
$1 868,66
$907,13
$1 000,09
$1 098,55
$1 448,31
$1 125,74
$1 218,70
$1 317,16
$1 666,92
$1 344,35
$1 437,31
$1 535,77
$1 885,53
$218,61
Toc - Plan #49 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Silver Care on Demand 4000 EPO Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$341,13
$387,18
$435,96
$609,25
$925,82
$557,75
$603,80
$652,58
$825,87
$774,37
$820,42
$869,20
$1 042,49
$990,99
$1 037,04
$1 085,82
$1 259,11
$216,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$682,26
$774,36
$871,92
$1 218,50
$1 851,64
$898,88
$990,98
$1 088,54
$1 435,12
$1 115,50
$1 207,60
$1 305,16
$1 651,74
$1 332,12
$1 424,22
$1 521,78
$1 868,36
$216,62
Toc - Plan #50 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Silver Care on Demand 4000 EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$330,88
$375,55
$422,87
$590,96
$898,01
$540,99
$585,66
$632,98
$801,07
$751,10
$795,77
$843,09
$1 011,18
$961,21
$1 005,88
$1 053,20
$1 221,29
$210,11
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$661,76
$751,10
$845,74
$1 181,92
$1 796,02
$871,87
$961,21
$1 055,85
$1 392,03
$1 081,98
$1 171,32
$1 265,96
$1 602,14
$1 292,09
$1 381,43
$1 476,07
$1 812,25
$210,11
Toc - Plan #51 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Bronze Essential 7500 EPO Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$266,50
$302,48
$340,59
$475,97
$723,28
$435,73
$471,71
$509,82
$645,20
$604,96
$640,94
$679,05
$814,43
$774,19
$810,17
$848,28
$983,66
$169,23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$533,00
$604,96
$681,18
$951,94
$1 446,56
$702,23
$774,19
$850,41
$1 121,17
$871,46
$943,42
$1 019,64
$1 290,40
$1 040,69
$1 112,65
$1 188,87
$1 459,63
$169,23
Toc - Plan #52 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Bronze Essential 7500 EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$258,49
$293,38
$330,34
$461,66
$701,53
$422,63
$457,52
$494,48
$625,80
$586,77
$621,66
$658,62
$789,94
$750,91
$785,80
$822,76
$954,08
$164,14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$516,98
$586,76
$660,68
$923,32
$1 403,06
$681,12
$750,90
$824,82
$1 087,46
$845,26
$915,04
$988,96
$1 251,60
$1 009,40
$1 079,18
$1 153,10
$1 415,74
$164,14
Toc - Plan #53 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Bronze Care on Demand 8000 EPO Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$253,06
$287,22
$323,41
$451,97
$686,81
$413,75
$447,91
$484,10
$612,66
$574,44
$608,60
$644,79
$773,35
$735,13
$769,29
$805,48
$934,04
$160,69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$506,12
$574,44
$646,82
$903,94
$1 373,62
$666,81
$735,13
$807,51
$1 064,63
$827,50
$895,82
$968,20
$1 225,32
$988,19
$1 056,51
$1 128,89
$1 386,01
$160,69
Toc - Plan #54 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Bronze Care on Demand 8000 EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$245,44
$278,58
$313,68
$438,36
$666,14
$401,30
$434,44
$469,54
$594,22
$557,16
$590,30
$625,40
$750,08
$713,02
$746,16
$781,26
$905,94
$155,86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$490,88
$557,16
$627,36
$876,72
$1 332,28
$646,74
$713,02
$783,22
$1 032,58
$802,60
$868,88
$939,08
$1 188,44
$958,46
$1 024,74
$1 094,94
$1 344,30
$155,86
Toc - Plan #55 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Silver 3500 EPO Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$354,89
$402,81
$453,56
$633,84
$963,18
$580,25
$628,17
$678,92
$859,20
$805,61
$853,53
$904,28
$1 084,56
$1 030,97
$1 078,89
$1 129,64
$1 309,92
$225,36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$709,78
$805,62
$907,12
$1 267,68
$1 926,36
$935,14
$1 030,98
$1 132,48
$1 493,04
$1 160,50
$1 256,34
$1 357,84
$1 718,40
$1 385,86
$1 481,70
$1 583,20
$1 943,76
$225,36
Toc - Plan #56 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Alliance Silver 3500 EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$337,15
$382,66
$430,87
$602,15
$915,02
$551,24
$596,75
$644,96
$816,24
$765,33
$810,84
$859,05
$1 030,33
$979,42
$1 024,93
$1 073,14
$1 244,42
$214,09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$674,30
$765,32
$861,74
$1 204,30
$1 830,04
$888,39
$979,41
$1 075,83
$1 418,39
$1 102,48
$1 193,50
$1 289,92
$1 632,48
$1 316,57
$1 407,59
$1 504,01
$1 846,57
$214,09
Toc - Plan #57 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Alliance Silver Care on Demand 4000 EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$324,05
$367,80
$414,14
$578,75
$879,47
$529,82
$573,57
$619,91
$784,52
$735,59
$779,34
$825,68
$990,29
$941,36
$985,11
$1 031,45
$1 196,06
$205,77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$648,10
$735,60
$828,28
$1 157,50
$1 758,94
$853,87
$941,37
$1 034,05
$1 363,27
$1 059,64
$1 147,14
$1 239,82
$1 569,04
$1 265,41
$1 352,91
$1 445,59
$1 774,81
$205,77
Toc - Plan #58 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Alliance Bronze Essential 7500 EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$253,17
$287,35
$323,56
$452,17
$687,12
$413,94
$448,12
$484,33
$612,94
$574,71
$608,89
$645,10
$773,71
$735,48
$769,66
$805,87
$934,48
$160,77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$506,34
$574,70
$647,12
$904,34
$1 374,24
$667,11
$735,47
$807,89
$1 065,11
$827,88
$896,24
$968,66
$1 225,88
$988,65
$1 057,01
$1 129,43
$1 386,65
$160,77
Toc - Plan #59 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Alliance Bronze HDHP 5700 EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$5,700 $11,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$257,43
$292,18
$328,99
$459,77
$698,66
$420,90
$455,65
$492,46
$623,24
$584,37
$619,12
$655,93
$786,71
$747,84
$782,59
$819,40
$950,18
$163,47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$514,86
$584,36
$657,98
$919,54
$1 397,32
$678,33
$747,83
$821,45
$1 083,01
$841,80
$911,30
$984,92
$1 246,48
$1 005,27
$1 074,77
$1 148,39
$1 409,95
$163,47
Toc - Plan #60 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Alliance Bronze Care on Demand 8000 EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$240,41
$272,86
$307,24
$429,37
$652,47
$393,07
$425,52
$459,90
$582,03
$545,73
$578,18
$612,56
$734,69
$698,39
$730,84
$765,22
$887,35
$152,66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$480,82
$545,72
$614,48
$858,74
$1 304,94
$633,48
$698,38
$767,14
$1 011,40
$786,14
$851,04
$919,80
$1 164,06
$938,80
$1 003,70
$1 072,46
$1 316,72
$152,66
Toc - Plan #61 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Regence Standard Silver Plan EPO Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$373,71
$424,16
$477,60
$667,45
$1 014,25
$611,02
$661,47
$714,91
$904,76
$848,33
$898,78
$952,22
$1 142,07
$1 085,64
$1 136,09
$1 189,53
$1 379,38
$237,31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$747,42
$848,32
$955,20
$1 334,90
$2 028,50
$984,73
$1 085,63
$1 192,51
$1 572,21
$1 222,04
$1 322,94
$1 429,82
$1 809,52
$1 459,35
$1 560,25
$1 667,13
$2 046,83
$237,31
Toc - Plan #62 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Regence Standard Bronze Plan EPO Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$271,54
$308,19
$347,02
$484,96
$736,95
$443,97
$480,62
$519,45
$657,39
$616,40
$653,05
$691,88
$829,82
$788,83
$825,48
$864,31
$1 002,25
$172,43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$543,08
$616,38
$694,04
$969,92
$1 473,90
$715,51
$788,81
$866,47
$1 142,35
$887,94
$961,24
$1 038,90
$1 314,78
$1 060,37
$1 133,67
$1 211,33
$1 487,21
$172,43
Toc - Plan #63 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Regence Standard Silver Plan EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$362,51
$411,45
$463,29
$647,45
$983,86
$592,70
$641,64
$693,48
$877,64
$822,89
$871,83
$923,67
$1 107,83
$1 053,08
$1 102,02
$1 153,86
$1 338,02
$230,19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$725,02
$822,90
$926,58
$1 294,90
$1 967,72
$955,21
$1 053,09
$1 156,77
$1 525,09
$1 185,40
$1 283,28
$1 386,96
$1 755,28
$1 415,59
$1 513,47
$1 617,15
$1 985,47
$230,19
Toc - Plan #64 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Regence Standard Bronze Plan EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$263,42
$298,98
$336,65
$470,47
$714,92
$430,69
$466,25
$503,92
$637,74
$597,96
$633,52
$671,19
$805,01
$765,23
$800,79
$838,46
$972,28
$167,27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$526,84
$597,96
$673,30
$940,94
$1 429,84
$694,11
$765,23
$840,57
$1 108,21
$861,38
$932,50
$1 007,84
$1 275,48
$1 028,65
$1 099,77
$1 175,11
$1 442,75
$167,27
Toc - Plan #65 Regence BlueCross BlueShield of Oregon
Gold

(EPO) Regence Standard Gold Plan EPO Individual and Family Network

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$431,10
$489,30
$550,95
$769,94
$1 170,00
$704,85
$763,05
$824,70
$1 043,69
$978,60
$1 036,80
$1 098,45
$1 317,44
$1 252,35
$1 310,55
$1 372,20
$1 591,19
$273,75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$862,20
$978,60
$1 101,90
$1 539,88
$2 340,00
$1 135,95
$1 252,35
$1 375,65
$1 813,63
$1 409,70
$1 526,10
$1 649,40
$2 087,38
$1 683,45
$1 799,85
$1 923,15
$2 361,13
$273,75
Toc - Plan #66 Regence BlueCross BlueShield of Oregon
Gold

(EPO) Regence Standard Gold Plan EPO OHSU Health

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$418,16
$474,61
$534,41
$746,84
$1 134,89
$683,69
$740,14
$799,94
$1 012,37
$949,22
$1 005,67
$1 065,47
$1 277,90
$1 214,75
$1 271,20
$1 331,00
$1 543,43
$265,53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$836,32
$949,22
$1 068,82
$1 493,68
$2 269,78
$1 101,85
$1 214,75
$1 334,35
$1 759,21
$1 367,38
$1 480,28
$1 599,88
$2 024,74
$1 632,91
$1 745,81
$1 865,41
$2 290,27
$265,53
Toc - Plan #67 Regence BlueCross BlueShield of Oregon
Gold

(EPO) Regence Standard Gold Plan EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$7,300 $14,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$409,54
$464,83
$523,40
$731,45
$1 111,50
$669,60
$724,89
$783,46
$991,51
$929,66
$984,95
$1 043,52
$1 251,57
$1 189,72
$1 245,01
$1 303,58
$1 511,63
$260,06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$819,08
$929,66
$1 046,80
$1 462,90
$2 223,00
$1 079,14
$1 189,72
$1 306,86
$1 722,96
$1 339,20
$1 449,78
$1 566,92
$1 983,02
$1 599,26
$1 709,84
$1 826,98
$2 243,08
$260,06
Toc - Plan #68 Regence BlueCross BlueShield of Oregon
Silver

(EPO) Regence Standard Silver Plan EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$3,650 $7,300 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$355,01
$402,93
$453,70
$634,04
$963,49
$580,44
$628,36
$679,13
$859,47
$805,87
$853,79
$904,56
$1 084,90
$1 031,30
$1 079,22
$1 129,99
$1 310,33
$225,43
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$710,02
$805,86
$907,40
$1 268,08
$1 926,98
$935,45
$1 031,29
$1 132,83
$1 493,51
$1 160,88
$1 256,72
$1 358,26
$1 718,94
$1 386,31
$1 482,15
$1 583,69
$1 944,37
$225,43
Toc - Plan #69 Regence BlueCross BlueShield of Oregon
Expanded Bronze

(EPO) Regence Standard Bronze Plan EPO Legacy LHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-675-6570

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$257,99
$292,81
$329,70
$460,76
$700,17
$421,81
$456,63
$493,52
$624,58
$585,63
$620,45
$657,34
$788,40
$749,45
$784,27
$821,16
$952,22
$163,82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$515,98
$585,62
$659,40
$921,52
$1 400,34
$679,80
$749,44
$823,22
$1 085,34
$843,62
$913,26
$987,04
$1 249,16
$1 007,44
$1 077,08
$1 150,86
$1 412,98
$163,82

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Clackamas County here.

Clackamas County is in “Rating Area 1” of Oregon.

Currently, there are 69 plans offered in Rating Area 1.

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2021 Obamacare Plans for Clackamas County, OR

Plan Browser: 69 Plans
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