Oregon health plan · 2025

KP Oregon Standard Silver Plan · 71287OR0420003

Kaiser Foundation Health Plan of the Northwest offers this marketplace health insurance plan (Plan ID 71287OR0420003) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: EPO CSR: Zero Cost Sharing Plan Variation Issuer: Kaiser Foundation Health Plan of the Northwest
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 100.00%. Expect to pay roughly 0.00% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 100.00% (0.00% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$241 – $1236

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$0

$0 per group

Review MOOP rules

Office visits

Primary care $0.00
Specialist $0.00
HSA Not eligible

Drug tiers

Generic $0.00
Preferred brand $0.00

View formulary tiers

$432 / mo before subsidies

≈ $5184 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1256 / mo before subsidies

≈ $15072 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1480 / mo before subsidies

≈ $17760 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1006 / mo before subsidies

≈ $12072 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

$0.00

Emergency Room Services

$0.00

Durable Medical Equipment

$0.00

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Oregon). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Zero Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

$0.00

Emergency Room Services

$0.00

Durable Medical Equipment

$0.00

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 71287OR0420003
Coverage year 2025
State Oregon
Issuer Kaiser Foundation Health Plan of the Northwest
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 71287OR0420003-02
Available variants

Standard Off Exchange Plan · 71287OR0420003-00

Standard On Exchange Plan · 71287OR0420003-01

Open to Indians below 300% FPL · 71287OR0420003-02

Open to Indians above 300% FPL · 71287OR0420003-03

73% AV Silver Plan · 71287OR0420003-04

87% AV Silver Plan · 71287OR0420003-05

94% AV Silver Plan · 71287OR0420003-06
Last plan update Thu, 17 Oct 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Oregon N/A
PCPs in Oregon N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers Oregon All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

2,712 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 1,824
SPECIALTY 501
NON-PREFERRED-BRAND 387
Prior authorization Drugs
Required 1,061
Not Required 1,651
Step therapy Drugs
Required 0
Not Required 2,712
Quantity limits Drugs
Has Limit 692
No Limit 2,020

Customer highlights

What stands out for members

  • Issuer: Kaiser Foundation Health Plan of the Northwest · Plan ID 71287OR0420003 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 71287OR0420003-02 (Open to Indians below 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

nan

Exclusions: nan

Diabetes Education

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 3.0 Hours per Year

Covers three hours of education per year if there is a significant change in condition or treatment; covers one diabetes self-management education program at the time of diagnosis.

Exclusions: nan

Home Health Care Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met

Exclusions: nan

Preventive Care/Screening/Immunization

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Visit limit does not apply to treatment of mental health conditions.

Exclusions: nan

Rehabilitative Speech Therapy

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

30 visits per condition per calendar year. Visit limit does not apply to treatment of mental health conditions.

Exclusions: nan

Specialist Visit

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Telehealth-Office Visit

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Telehealth allows a Member, or person acting on the Members behalf, to interact with a Participating Provider who is not physically at the same location. We cover telehealth Services at no Charge when all of the following are true: The Service is otherwise covered under this EOC. The Service is determined by a Participating Provider to be Medically Necessary. Medical Group determines the Service may be safely and effectively provided using telehealth, according to generally accepted health care practices and standards.

Exclusions: nan

Telehealth-Specialist Visit

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Telehealth allows a Member, or person acting on the Members behalf, to interact with a Participating Provider who is not physically at the same location. We cover telehealth Services at no Charge when all of the following are true: The Service is otherwise covered under this EOC. The Service is determined by a Participating Provider to be Medically Necessary. Medical Group determines the Service may be safely and effectively provided using telehealth, according to generally accepted health care practices and standards.

Exclusions: nan

Urgent Care Centers or Facilities

$0.00
Tier 1 in-network $0.00
Out-of-network $0.00

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Dialysis

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

$5,000 limit on non-Essential Health Benefit Durable Medical equipment.

Exclusions: nan

Emergency Room Services

$0.00
Tier 1 in-network $0.00
Out-of-network $0.00

nan

Exclusions: nan

Emergency Transportation/Ambulance

$0.00
Tier 1 in-network $0.00
Out-of-network $0.00

nan

Exclusions: nan

Hospice Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Respite care provided in a nursing facility subject to a maximum of five consecutive days and to a lifetime maximum benefit of 30 days.

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Visit limit does not apply to treatment of mental health conditions.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 60.0 Days per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met

Exclusions: nan

Transplant

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

One hearing aid per hearing impaired ear if prescribed, fitted, and dispensed by a licensed audiologist with the approval of a licensed physician. Coverage will be provided every 36 months as medically necessary for the treatment of a member's hearing loss.

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Well Baby Visits and Care

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Insulin: $35 max out of pocket for 30 day supply prior to deductible

Exclusions: nan

Medical Service Drugs

Coverage details pending

nan

Exclusions: nan

Non-Preferred Brand Drugs

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Insulin: $35 max out of pocket for 30 day supply prior to deductible

Exclusions: nan

Preferred Brand Drugs

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Insulin: $35 max out of pocket for 30 day supply prior to deductible

Exclusions: nan

Specialty Drugs

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Insulin: $35 max out of pocket for 30 day supply prior to deductible

Exclusions: nan

Zero Cost Share Preventative Drugs

Coverage details pending

nan

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Hormone Therapy

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 5.0 Visit(s) per Lifetime

Visit limit does not apply to treatment of mental health conditions.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Acupuncture

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 12.0 Visit(s) per Year

nan

Exclusions: nan

Allergy Testing

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Cosmetic or reconstructive surgery must take place within 18 months after the injury, surgery, scar, or defect first occurred unless medically necessary.

Exclusions: nan

Eye Glasses for Children

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Gender Affirming Care

Coverage details pending

Gender affirming care is covered when determined by a provider as medically necessary and follows accepted standards of care. Please check with the insurance carrier for coverage information, including any limitations and exclusions.

Exclusions: nan

Habilitation Services

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Visit limit does not apply to treatment of mental health conditions.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Non-Preferred Brand

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Non-Preferred Generic

Coverage details pending

nan

Exclusions: nan

Preferred Brand

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Preferred Generic

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Insulin: $35 max out of pocket for 30 day supply prior to deductible

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Cosmetic or reconstructive surgery must take place within 18 months after the injury, surgery, scar, or defect first occurred unless medically necessary.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Covered for patients with diabetes mellitus.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

Coverage details pending

nan

Exclusions: nan

Variant attributes

KP Oregon Standard Silver Plan · Variant 71287OR0420003-02

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Zero Cost Sharing Plan Variation

HIOS Product ID

71287OR042

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

71287OR0420003-02

Plan Marketing Name

KP Oregon Standard Silver Plan

Plan Variant Marketing Name

KP Oregon Standard Silver Plan - AI/0

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

100.00%

Issuer ID

71287

Issuer Marketplace Marketing Name

Kaiser Permanente

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

ORN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency medical conditions, including prescription drugs

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency medical conditions, including prescription drugs

Service Area ID

ORS001

State Code

OR

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

1.0

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

ORF018

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$100

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

3

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$0

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Design 3

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

EHB Percent of Total Premium

0.9985

First Tier Utilization

100%

Import Date

2024-10-17 20:01:47

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$0

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

EPO

QHP/Non QHP

Both

Source Name

SERFF

Specialist Requiring a Referral

A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.

Plan ID

71287OR0420003

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Oregon?

KP Oregon Standard Silver Plan (71287OR0420003) is a Silver EPO from Kaiser Foundation Health Plan of the Northwest in Oregon for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does KP Oregon Standard Silver Plan support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is KP Oregon Standard Silver Plan HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does KP Oregon Standard Silver Plan support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with KP Oregon Standard Silver Plan?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for KP Oregon Standard Silver Plan?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency medical conditions, including prescription drugs

Does KP Oregon Standard Silver Plan cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergency medical conditions, including prescription drugs

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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Add at least two plans to launch side-by-side comparisons.