Regence Standard Bronze Plan Individual and Family Network - 77969OR5290002 Health Insurance Plan
Regence BlueCross BlueShield of Oregon health insurance plan with the Plan ID 77969OR5290002. The plan is called Regence Standard Bronze Plan Individual and Family Network.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 63.10% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 36.90% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 63.10% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 36.90% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.
| Health Insurance Plan ID | 77969OR5290002 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Oregon | ||||||||||||||||||
| Health Insurance Issuer | Regence BlueCross BlueShield of Oregon | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 77969OR5290002-03 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 04 Nov 2025 05:30 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 77969OR5290002-00 Standard On Exchange Plan - 77969OR5290002-01 |
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| Last Plan Update Date | Tue, 13 Aug 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 04 Nov 2025 05:30 GMT |
Benefits of Regence Standard Bronze Plan Individual and Family Network Health Insurance Plan, 77969OR5290002-03
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Accidental Dental
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Acupuncture
Limit: 12.0 Visit(s) per Year Exclusions: nan nan |
YES | $50.00 |
100.00% |
| Allergy Testing
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan nan |
NO | ||
| Chemotherapy
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Chiropractic Care
Limit: 20.0 Visit(s) per Year Exclusions: nan nan |
YES | $50.00 |
100.00% |
| Cosmetic Surgery
Exclusions: nan one attempt to correct a scar or defect that resulted from an accidental injury or treatment for an accidental injury or one attempt to correct a scar or defect on the head or neck that resulted from a surgery (more than one attempt is covered if medically necessary) |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Dental Check-Up for Children
Exclusions: nan nan |
NO | ||
| Diabetes Education
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Dialysis
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Durable Medical Equipment
Exclusions: nan Hardware to correct visual defect due to severe medical or surgical problem such as stroke, neurological disease, trauma or eye surgery other than refractive procedures limited to one pair of glasses (frames and lenses) or contact lenses per calendar year. |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Emergency Room Services
Exclusions: nan Out of service area coverage is available |
YES | 0.00% Coinsurance after deductible |
0.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance
Exclusions: nan Out of service area coverage is available |
YES | 0.00% Coinsurance after deductible |
0.00% Coinsurance after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: nan One pair of lenses and one frame per year (contacts in lieu of glasses) |
YES | No Charge |
100.00% |
| Gender Affirming Care
Exclusions: nan 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. |
YES | ||
| Generic Drugs
Exclusions: nan Insulin limit of $35 for a 30 day supply and $105 for a 90-day supply |
YES | $25.00 |
100.00% |
| Habilitation Services
Limit: 30.0 Visit(s) per Year Exclusions: nan Visit limit does not apply to treatment of mental health conditions. |
YES | $50.00 |
100.00% |
| Hearing Aids
Exclusions: nan Hearing assistance coverage complies with state and federal law |
YES | 0.00% |
100.00% |
| Home Health Care Services
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Hormone Therapy
Exclusions: nan nan |
YES | ||
| Hospice Services
Exclusions: nan Respite care - max of 5 consecutive days; lifetime max of 30 days |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan nan |
NO | ||
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan $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. |
YES | $50.00 |
100.00% |
| Non-Preferred Brand Drugs
Exclusions: nan Insulin limit of $35 for a 30 day supply and $105 for a 90-day supply |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Nutritional Counseling
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan nan |
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan $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. |
YES | $50.00 |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Outpatient Rehabilitation Services
Limit: 30.0 Visit(s) per Year Exclusions: nan Visit limit does not apply to treatment of mental health conditions. |
YES | $50.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Preferred Brand Drugs
Exclusions: nan Insulin limit of $35 for a 30 day supply and $105 for a 90-day supply |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Prenatal and Postnatal Care
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan $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. |
YES | $50.00 |
100.00% |
| Private-Duty Nursing
Exclusions: nan nan |
NO | ||
| Prosthetic Devices
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Radiation
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Reconstructive Surgery
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 30.0 Visit(s) per Year Exclusions: nan Limit combined with Occupational, Physical, and Speech therapy. Visit limit does not apply to Mental Health/Substance Abuse. |
YES | $50.00 |
100.00% |
| Rehabilitative Speech Therapy
Limit: 30.0 Visit(s) per Year Exclusions: nan Limit combined with Occupational, Physical, and Speech therapy. Visit limit does not apply to Mental Health/Substance Abuse. |
YES | $50.00 |
100.00% |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Year Exclusions: nan nan |
YES | No Charge |
100.00% |
| Routine Foot Care
Exclusions: nan Covered when medically necessary |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Skilled Nursing Facility
Limit: 60.0 Days per Year Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Specialist Visit
Exclusions: nan nan |
YES | $150.00 |
100.00% |
| Specialty Drugs
Limit: 30.0 Item(s) per Month Exclusions: nan $500 cap per prescription for the Standard Gold Plan. First filled allowed at a retail pharamcy. Insulin limit of $35 for a 30 day supply and $105 for a 90-day supply |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan $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. |
YES | $50.00 |
100.00% |
| Telehealth - Primary Care
Exclusions: nan nan |
YES | $50.00 |
100.00% |
| Telehealth - Specialist
Exclusions: nan nan |
YES | $150.00 |
100.00% |
| Transplant
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan nan |
NO | ||
| Urgent Care Centers or Facilities
Exclusions: nan Out of service area coverage is available |
YES | $100.00 |
$100.00 |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan nan |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | 0.00% Coinsurance after deductible |
100.00% |
Regence Standard Bronze Plan Individual and Family Network Health Insurance Plan Variant 77969OR5290002-03 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.631032952688281 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 3 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Limited Cost Sharing Plan Variation |
| Dental Only Plan | No |
| Design Type | Design 3 |
| Disease Management Programs Offered | Heart Disease, Low Back Pain, Pain Management, Pregnancy |
| EHB Percent of Total Premium | 0.996 |
| First Tier Utilization | 100% |
| Formulary ID | ORF015 |
| Formulary URL | URL |
| HIOS Product ID | 77969OR529 |
| Import Date | 2024-08-13 20:01:38 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 63.10% |
| Issuer ID | 77969 |
| Issuer Marketplace Marketing Name | Regence BlueCross BlueShield of Oregon |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | ORN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 77969OR5290002-03 |
| Plan Marketing Name | Regence Standard Bronze Plan Individual and Family Network |
| Plan Type | EPO |
| Plan Variant Marketing Name | Regence Standard Bronze Plan Individual and Family Network |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $9,200 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $600 |
| SBC Scenario, Having Diabetes, Deductible | $900 |
| SBC Scenario, Having Diabetes, Limit | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $500 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,100 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ORS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | A provider focusing on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions |
| Plan ID | 77969OR5290002 |
| State Code | OR |
| 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 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $18400 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $9200 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,200 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,200 |
| 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 |
| Unique Plan Design | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Regence Standard Bronze Plan Individual and Family Network Health Insurance Plan, 77969OR5290002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Regence Standard Bronze Plan Individual and Family Network, 77969OR5290002 Health Insurance Plan, 77969OR5290002
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Does Regence Standard Bronze Plan Individual and Family Network Health Insurance Plan, 77969OR5290002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (77969OR5290002) Health Insurance Plan, Variant (77969OR5290002-03) offer Disease Management Programs?
Does (77969OR5290002) Health Insurance Plan, Variant (77969OR5290002-03) have Out Of Country Coverage?
Does (77969OR5290002) Health Insurance Plan, Variant (77969OR5290002-03) have Out of Service Area Coverage?
Does (77969OR5290002) Health Insurance Plan, Variant (77969OR5290002-03) offer Disease Management Programs?
Does Regence Standard Bronze Plan Individual and Family Network Health Insurance Plan, Variant (77969OR5290002-03) offer Disease Management Programs for Heart disease?
Does Regence Standard Bronze Plan Individual and Family Network Health Insurance Plan, Variant (77969OR5290002-03) offer Disease Management Programs for Low back pain?
Does Regence Standard Bronze Plan Individual and Family Network Health Insurance Plan, Variant (77969OR5290002-03) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 04 Nov 2025 05:30 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API