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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 some of your 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, 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.

Service Your Cost* Approval/Referral Limits to Care
Primary Care Provider $0 Not required No limit with assigned PCP
Specialist $0 Not required No limit with In-Network Specialist

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay. 

Service Your Cost* Approval/Referral Limits to Care
Colonoscopies $0 Not required As recommended by PCP
Family Planning*** $0 Not required Sterilization requires consent form be fully completed by physician and member before services are given
Mammograms (breast X-rays) for Women $0 Referral required As recommended by PCP
Prostate Exams for Men $0 Not required Covered as a specialist visit if member presents with a problem
Routine Physicals
$0 Not required As recommended by PCP
Screening for Sexually Transmitted Diseases (STDs)
$0 Not required No limits
Testing and Counseling for AIDS and HIV
$0 Not required No limits
Well-child Visits for Babies, Children and Teens
$0 Not required As recommended by PCP
Women’s Exams
$0 Not required As recommended by PCP

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

*** You can go to an out of network provider for Family Planning services and supplies when you have prior approval.

Service Your Cost* Approval/Referral Limits to Care
Contraceptives $0 Some drugs may require approval with a prescription Up to a 90-day supply with prescription
Mental Health Medications** N/A Not covered by IHN-CCO Mental Health Medications are covered by OHP, see Mental Health Prescriptions for more details
Other Medications $0 Some drugs may require approval with a prescription Up to a 30-day supply with prescription

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

** These benefits are covered by OHA and are subject to change. Please call member services at 800-273-0557 to confirm benefits at time of service.

Service Your Cost* Approval/Referral Limits to Care
Blood Draw $0 Referral required No limit
CT Scans $0 Referral and approval required As recommended by PCP
MRIs $0 Referral and approval required As recommended with approval
X-rays $0 Referral required No limit

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

Service Your Cost* Approval/Referral Limits to Care
Preventative Vaccines $0 Not required Vaccines must be given at your provider’s office. Flu shots may be given at an In-Network pharmacy or health department. See Covered Pharmacies.
Work, Education or Travel Vaccines N/A Not a covered benefit These vaccines are not covered by IHN-CCO or OHP

Immunization schedule for 0-6 years
Immunization schedule for 7-18 years
Immunization schedule for 19 years and older

*This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

Service Your Cost* Approval/Referral Limits to Care
Breast Pump $0 Approval required if billed amount is over $300 or rental length greater than 3 months Covered with approval when provided by a contracted DME supplier.
Child Birthing/Lamaze/Breast Feeding Classes $0 Not required Covered if provided at a hospital in IHN-CCO’s service area (Benton Lincoln and Linn Counties). Contact Customer Service for details.
Postpartum Care (the care you get after your baby is born) $0 Not required No limit with In-Network Provider
Prenatal Visits with Your Doctor $0 Not required No limit
Routine Vision Services $0 Approval required Available for pregnant women. Contact Customer Service for details.
Dental Exams, Cleanings, X-rays $0 Not required You may have extra dental benefits during your pregnancy. Call your assigned dental plan for details.

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

Service Cost* Approval/Referral Limits to Care
Inpatient Hospital Admission $0 Approval required for stays longer than 96 hours (5 days). Emergency services do not require approval.

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

Service Cost* Approval/Referral Limits to Care
Emergencies $0 Emergency services do not require approval. No limit
Scheduled Surgery $0 Approval required No limit with approval

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

Service Cost* Approval/Referral Limits to Care
Circumcision for Newborn Boys N/A Approval is required if performed as an inpatient or outpatient surgery Not covered unless medically necessary
Newborn Inpatient Stay $0 Not required for stays less than 5 days Newborns will require their own insurance. Call the state of Oregon or your case manager to tell him about the birth and to get your newborn enrolled on the OHP. Approval is required for newborn stays of 5 days or longer.

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

Service Cost* Approval/Referral Limits to Care
Ambulatory Surgical Center or Outpatient Hospital $0 Approval required. Colonoscopies and GI, ear, nose, and throat endoscopes do not require prior approval. No limit with approval
In Office Procedures $0 Referral may be required May be limits depending on service

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

Service Cost* Approval/Referral Limits to Care
Acupuncture $0 Approval required if more than 30 visits per calendar year.  
Cardiac/Pulmonary Therapy $0 Approval required if more than 30 visits per calendar year.  
Massage Therapy $0 Approval required Massage Therapy is only covered when provided with other treatments during the same Physical Therapy Session. See PT and OT benefits.
Occupational Therapy (OT) $0 Approval required if more than 30 visits per calendar year No limit on visits for the first year following a serious injury to spinal cord, traumatic brain or cerebral vascular injuries. Prior approval required for more than 30 visits to verify injury.
Physical Therapy (PT) $0 Approval required if more than 30 visits per calendar year No limit on visits for the first year following a serious injury to spinal cord, traumatic brain or cerebral vascular injuries. Prior approval required for more than 30 visits to verify injury.
Speech Therapy (ST) $0 Approval required if more than 30 visits per calendar year No limit on visits for the first year following a serious injury to spinal cord, traumatic brain or cerebral vascular injuries. Prior approval required for more than 30 visits to verify injury.

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

Service Cost* Approval/Referral Limits to Care
Contact Lenses $0 Approval required  
Eye Hardware $0 Contact Customer Service Available for adults 21 and over only if pregnant or certain medical conditions/diagnoses
Medical Eye Exams $0 Contact Customer Service Available for all members with limitations
Routine Eye Exams $0 Contact Customer Service Available for adults 21 and over only if pregnant or certain medical conditions/diagnoses

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

Service Cost* Approval/Referral Limits to Care
Abortion** N/A Not required Not a covered service by IHN-CCO. This service is covered by the OHP.
Chiropractor $0 Approval required for out of network Approval based on OHP guidelines and the Prioritized list.
Endoscopies $0 Approval required for capsule/wireless endoscopy and motility monitoring studies.  
Hearing Exams and Screenings $0 Referral required No limits
Hearing Aids $0 Approval required Adults who meet criteria are limited to one (1) hearing aid every five (5) years, (two (2) may be authorized if certain criteria are met). Children who meet criteria are allowed two (2) hearing aids every three (3) years.
Home Health $0 Not required Non-medical assistance is not included and is not covere
Hospice $0 Not required No limits
Medical Equipment and Supplies (Durable Medical Equipment, DME) $0 Approval required for billed amounts over $300. Approval and limits based on OHP guidelines. Contact Customer Service for details.
Skilled Nursing Facilities (SNF) $0 Approval required for stays longer than 7 days. Limits apply. Contact Customer Service for details

* This cost only applies when services are given by an In-Network Provider. Any services with an Out-of-Network Provider must have prior authorization or approval, unless it is an emergency. If you do not get approval, you may have to pay.

** These benefits are covered by OHA and are subject to change. Please call member services at 800-273-0557 to confirm benefits at time of service.

The information on this page is a summary of your IHN-CCO benefits. For a full description of the benefits and services available to you, read your IHN-CCO Member Handbook.

2020 Member Handbook
Prioritized List of Health Services

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. Some examples of non-covered medical services are:

  • Treatment for conditions that get better on their own without going to the doctor, like colds.
  • Treatment for conditions that can be treated at home, such as corns, calluses and some skin conditions.
  • Cosmetic surgeries or treatments that only improve appearance, not function.
  • Services to help you get pregnant.

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.

Find Care

Looking for a medical provider or clinic covered by OHP/IHN-CCO network?
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Forms & Downloads

Here are a few forms you or your provider may need. These forms relate to your medical coverage:

Authorized Representative Form You have the right to choose an Authorized Representative. This person has your permission to discuss your health information with IHN-CCO.
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.