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The Benefits Committee is chartered to develop recommendations defining a set of essential health services that should be available to all Oregonians under a comprehensive reform plan. The committee is expected to finalize its recommendations on May 27. The current draft recommendations include:
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A tiered copayment system with high deductibles, especially for hospital services.
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The system is based on the Oregon Health Plan’s prioritized list. Preventative and primary care services in a primary care home would have a no copayment.
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The same services in an inpatient setting would not be covered or would have a 10% copayment.
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Other “tiers,” or bands within the prioritized list, when provided in a hospital, would have different co-payments ranging from 20% to 80%.
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Actual cost-sharing could be subsidized for low-income individuals. Out-of-pocket costs would be limited for “value-based services.”
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Other services would have a high deductible estimated to be between $4,000 and $7,500.
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