Consolidated Insurance Services

Advantra Freedom

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2009 plans are below.
 
Plans are effective January 1, 2009.
 
To enroll in one of these plans or if you have questions on benefits not listed here please call us at (503) 936-8905.

 
Covered Services Freedom 2 Freedom 3 Freedom 5
Monthly premium $23 $31 $36
Maximum Out-of-Pocket limit $3,000 $3,350 $3,350
Prescription Drugs


- Deductible n/a n/a $0
- Tier 1 n/a n/a $7
- Tier 2 n/a n/a $30
- Tier 3 n/a n/a $73
- Tier 4 n/a n/a 30%
Office visits


PCP $15 $20 $15
Specialist $30 $30 $30
X-Rays $15 copay $30 copay $15 copay
Laboratory services $5 copay $5 copay $5 copay
Inpatient Hospital $180 copay $265 copay $180 copay

Days 1-5 Days 1-11 Days 1-6
Outpatient Surgery $90 $200 $90
Emergency Room $50 $50 $50
Urgent Care $15 $20 $15
Ambulance Services $150 $150 $150
Preventive Care


- Annual Physical Exam $0 $0 $0
- Immunizations $0 $0 $0
- GYN exams $0 $0 $0
- Screening Mammograms $0 $0 $0
- Bone Mass Measurements $0 $0 $0
- Colorectal Screening Exams $0 $0 $0
- Prostate Screening Exams $0 $0 $0
Vision $30 copay/ $100 limit $30 copay/ $100 limit $30 copay/ $100 limit
Hearing $30 copay/ $100 limit $30 copay/ $100 limit $30 copay/ $100 limit
Dental 50% coinsurance 50% coinsurance 50% coinsurance
* Mail order two month copay for 90day supply


Diabetes $0 copay on self-monitoring training, Nutrition Therapy.  You pay 20% of diabetes supplies.

Kyle Rogers Insurance * 1075 NW 123rd Ave #2 * Portland, OR * 97229
 

Your local independent agents serving Oregon & Washington