Your Medical Benefits
Explore Your Coverage
Sick? Let’s get you well again. Feeling fine? Let’s keep you that way! Your primary care provider (PCP) will work with you to meet your health care needs. If you need care from any other provider, hospital or clinic, your PCP is able to assist in coordinating services.
Below are types of covered medical benefits as a member of IHN-CCO. These services are covered when given by an in-network provider. If you think you need a service that is not listed in the handbook, you or your provider should contact us before you get the service.
The services listed are subject to the Prioritized List of Health Services and IHN-CCO and Oregon Health Plan rules. Benefits are subject to change.
- Doctor visits.
- Hospital stays.
- Immunizations/shots.
- Labor & delivery.
- Laboratory & X-ray.
- Newborn care.
- Outpatient surgery.
- Pregnancy & postpartum care.
- Prescription drugs.
- Preventive services.
- Specialty services.
- Therapy.
- Vision.
Read the Member Handbook for more details about your benefits.
2023 Member Handbook
Non-covered Services
Unfortunately, IHN-CCO and Oregon Health Plan cannot cover everything. We try to cover the most important services to treat common medical problems and keep you healthy.
Refer to the Non-Covered Services web page or the Member Handbook for a list of non-covered services.Getting Care
IHN-CCO will be your main contact for any questions you may have about your primary care provider (PCP). Your PCP will manage your medical care and treatment and make sure that you see specialists when needed. You can call your PCP’s office any time of day or night, every day of the week. Even if the office is closed, there is still someone available to help you.
Please ask your provider’s office about their ADA accessibility, like ramps and elevators, if you have special needs. Some doctors speak languages besides English. You can ask if the clinic has a provider who speaks your language.
IHN-CCO will help you choose a PCP or change your PCP if one has already been assigned to you. Make sure that you tell us if you are getting medical services that you need to continue. We don’t limit the PCP you choose, if they are in IHN-CCO’s provider network and accepting new patients. Review the current list of in-network PCPs or contact Customer Service.
IHN-CCO will help you choose a PCP or change your PCP if one has already been assigned to you. Make sure that you tell us if you are getting medical services that you need to continue. IHN-CCO doesn’t limit the PCP you choose, as long as they are in IHN-CCO’s provider network and accepting new patients.
It’s best to call us if you want to choose or change your PCP. Our Customer Service can be reached Monday through Friday, from 8 a.m. to 5 p.m.. Call us at 541-768-4550 or 800-832-4580 (TTY 800-735-2900). Or you can change or change your PCP by filling out this card and mailing it to us.
Review the current list of in-network PCPs or contact Customer Service.
Please ask your provider’s office about their ADA accessibility, like ramps and elevators, if you have special needs.
Some doctors speak languages besides English. You can ask if the clinic has a provider who speaks your language. You can have a language or sign language interpreter at your appointments if you want one. Learn more about IHN-CCO’s Interpreter Services.
A specialist is a provider who treats only certain health problems. For example, there are specialists who treat heart problems, joint pain or skin problems. Your PCP will usually be the one who decides if you need to see a specialist. This is done by what is called a referral. If your PCP thinks you should see a specialist they will send or call in a referral to the specialist. Some referrals also require approval, or prior authorization, from IHN-CCO.
Review the list of in-network specialists or contact Customer Service.
Forms & Downloads
Here are a few forms you or your provider may need. These forms relate to your medical coverage:
| Choose Primary Care Provider Card | Choose or change your primary care provider by filling out this card and mailing it to us. |
|---|---|
| Prior Authorization Request Form | This form is for your provider. It is used to request an approval, or prior authorization, for medical services. |