Specific doctors, pharmacies, hospitals, and other healthcare providers are in your health plan network. You pay for part of the cost of your medical care and you will pay less if you use in-network providers.
It's a good idea to plan where you will get in-network care before you need it.
Use our Find a Doctor tool to locate a nearby in-network doctor, urgent care center, emergency room, and pharmacy. You'll be glad you know where to go when you need urgent or emergency care, or prescriptions filled in a hurry.
Whether you enrolled through HealthCare.gov, through a producer, or directly with LifeWise, you will send your payment to LifeWise.
Use one of these five convenient options to pay your bill:
- By automatic funds transfer (AFT)
- Online
- By phone
- Online via your bank
- By mail
For more about paying your monthly premiums and bills, visit Pay my bill under Member Services.
Your new exclusive provider organization (EPO) plan gives you access to an extensive regional network of doctors and hospitals across the Pacific Northwest, including most major health systems in Oregon.
Your EPO plan only covers the cost of care from an in-network doctor, pharmacy, or urgent care center in Oregon, Washington, and Alaska, unless you have a medical emergency. If you receive non-emergency care from an out-of-network healthcare provider, you'll be responsible for the full cost of that care.
To find a provider, log in and use the Find a Doctor tool.
Emergency rooms are only for severe pain or life-threatening emergencies, such as severe stomach or chest pain, difficulty breathing, or broken bones.
Urgent care clinics provide care for non-life threatening health needs that can't wait until the next day. They're usually available evenings and weekends.
Always call 911 if health or life is in danger. If you're not sure, call the 24-Hour NurseLine, 800-841-8343.
Yes. If you're managing a chronic condition such as asthma, diabetes, heart disease, or COPD, personal health support is included in your plan. Call 800-596-3440 (888-517-3508 TTY/TDD) or email healthhelp@lifewiseor.com.
To get the most from your health plan, each family member should have a primary care doctor, also called a primary care provider or PCP. This doctor gets to know your medical history, and your medical records are all in one place, which means better care and more efficient visits.
Your office visit copays are lower if you notify us of your PCP selection, whether you choose your PCP online or call Customer Service.
You can choose from several types of providers, including family medicine doctor, naturopath, pediatrician, and geriatric specialist, or a physician's assistant or nurse practitioner.
To help you understand your EPO plan, here's an example to explain how it works.*
Let's say your plan has in-network services covered with a $2,500 deductible, $35 office visit copay, 30% coinsurance , and $6,350 out-of-pocket maximum . You pay these costs.
1. Starting on day one of your plan year, you pay for most care and medical services (diagnostic tests, emergency care, prescriptions), until you pay a total of $2,500, your deductible. For office visits, you pay only a $35 copay, even though you have not met your deductible.
Some care, including most preventive care, is fully covered before you meet your deductible.
2. After you've paid $2,500, your plan's coverage kicks in. You pay 30% of the cost of your covered care (your coinsurance). Your plan pays the other 70%.
For example, if the total cost of an office visit was $200, you'd pay $60 coinsurance. Your plan would pay the rest-$140. For an office visit, you'd also pay a $35 copay.
3. After you've paid a total of $6,350 in deductible, copays, and coinsurance, you've met your annual out-of-pocket maximum. Your plan pays 100% of your covered care for the rest of the plan year.
*This is an example only. For details about your plan's actual deductible, copay, coinsurance, and out-of-pocket maximum amounts, see your summary of benefits and benefit booklet on lifewiseor.com.To see your summary of benefits and coverage and benefit booklet, log in and go to Benefit Plans. To request a paper copy of these documents, call Customer Service at 800-596-3440.