24 The Mainline Group Benefits, Insurance Discounts Legislation passed in 2023 changed the landscape for Oregon health insurance plans. Oregon Senate Bill 1529 passed in 2022; and then the bill was further modified by House Bill 3008 during 2023. The net effect of these two bills is a $5 copay for each of the first three office visits for many health plans in Oregon. Certain high deductible plans will not offer this benefit. What does this mean to insured health care consumers? Normal office visit member responsibilities range from $20 to $50 per visit to the primary care provider (PCP). Beginning January 2024, or upon renewal of a plan during 2024, that copay will change. The new law requires all plans to charge the maximum of $5 for the first three visits to the Primary care provider. Certain high deductible plans will not offer this benefit. Consult your benefits specialist if you have a high deductible plan. This brings up a larger question. What do all the numbers of a health plan mean? Let us look deeper into one specific plan. The insurance plans above are from the Associated Oregon Loggers Health Benefit Trust. The bottom plan is GSA25-1000-2-6000. How does the new law affect this policy? The policy lists PCP office visits as $25 in network and $50 for a specialist. Under the new law, that amount now will begin for the fourth visit. The first three PCP visits will be at $5 each. It is important to understand the deductible and maximum out-of-pocket. After three office visits, a policy holder has only spent $15 toward their deductible. The policy holder could go to the PCP 59 more times that year before spending up to the $1,500 deductible. The deductible and out-of-pocket maximum. These may appear as abstract numbers to many people. Scenario 1—A covered family of six, with employee, spouse and four children: Each child gets a sports physical for school. The charge is $5 each for a total of $20. Dad cuts his hand cleaning fish and goes into the ER because it is Sunday. Charge is $250. Little Jimmy and Freddy both get sick mid-year and go in to the doctor. There are two more $5 copays. At this rate, the family will not spend enough on health care to reach the deductible or out-of-pocket maximum. $5 Health Copay Mandated for 2024— and General Insurance Numbers ›By Dave Boyd, Insurance Group Manager
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