HEALTH PLAN OVERVIEW At a glance: 2020 Regence Individual ... · • Pediatric vision is an...
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HEALTH PLAN OVERVIEW Deductible Out-of-pocket maximum In-network copay Coinsurance Rx tiers In Out In Out Primary Telehealth Secure Chat Specialty Urgent In Out T1 T2 T3 T4 T5 T6 Silver Care on Demand 4000 EPO $4,000* Not covered $8,150* Not covered $0 $0 20% Not covered $15 25% 30% 50% 40% 50% Bronze Care on Demand 8000 EPO $8,000* Not covered $8,150* Not covered $0 $0 20% Not covered $15 25% 30% 50% 40% 50% Standard Silver Plan EPO $3,550* Not covered $8,150* Not covered $40 $40 $40 $80 $70 30% Not covered $15 25% $60 50% 40% 50% Standard Bronze Plan EPO $7,900* Not covered $7,900* Not covered $45 $45 $45 $90 0% Not covered $15 0% 0% 0% 0% 0% Bronze Essential 7500 EPO $7,500* Not covered $8,150* Not covered $60/x3** $10 $0 $60/x3** $60/x3** 10% Not covered $15 10% 20% 50% 40% 50% Silver HSA 2700 EPO Individual $2,700 Not covered $6,900 Not covered 20% Not covered 20% 25% 30% 50% 40% 50% Family $5,400 Not covered $13,800 † Not covered 20% Not covered 20% 25% 30% 50% 40% 50% Bronze HSA 5200 EPO Individual $5,200 Not covered $6,900 Not covered 50% Not covered 30% 35% 40% 50% 40% 50% Family $10,400 Not covered $13,800 † Not covered 50% Not covered 30% 35% 40% 50% 40% 50% †No individual family member pays more than the individual out-of-pocket max. *Annual individual. Family is 2x the individual. **Primary, specialty and urgent visits all count toward the combined limit of 3 visits on the Essential plan. Blue box = Deductible waived Gray box = Deductible applies Virtual visits from anywhere 24/7/365 • All of our plans cover Doctor On Demand TM , which lets you access board-certified doctors via the app or video chat. • Telehealth visits are covered on most plans before you meet your deductible—and cost less than a traditional office visit. • New! Secure chat with a doctor benefit is available for $0 on most plans. This benefit allows you to connect with a doctor from your phone or the web with a secure chat interface. Preventive care is covered 100% • Routine physicals • Immunizations • Preventive drugs • Contraceptives (we cover options in each FDA-approved contraceptive method category at no cost to you, including generics) Pediatric dental • Pediatric dental is an essential health benefit and embedded in all non-Standard plans for in-network providers only. Pediatric vision provided by VSP ® Vision Care • Pediatric vision benefits are administered through VSP. • You can find VSP Choice providers at regence.com. • Pediatric vision is an essential health benefit and embedded in all plans for in-network providers only. Adult dental, vision and IAP buy-up • Adults can add a product that combines dental, vision and the Individual Assistance Program. • Vision benefits are administered through VSP ® Vision Care. Find VSP Choice providers at regence.com. • Four counseling sessions per incident and other support services are provided at no member cost. Pharmacy features & benefits • MedSavvy ® – Uses medication grades for safety and effectiveness to help you learn about and compare medications. – Tells you how much a medication costs based on your benefits. • 90 days of medication at select retail pharmacies or through home delivery (excludes specialty medications). • $5 off regular copay or 5% regular coinsurance at preferred pharmacies. • Our HSA plans’ Optimum Value Drug List waives the deductible on listed preventive drugs for cardiovascular disease, high cholesterol, diabetes, osteoporosis, depression and respiratory illness. At a glance: 2020 Regence Individual plans in Oregon with the Individual and Family Network Plan availability by county We sell these plans to residents of the following counties: Baker, Benton, Clatsop, Columbia, Crook, Deschutes, Gilliam, Grant, Harney, Hood River, Jefferson, Lane, Lincoln, Linn, Malheur, Morrow, Sherman, Tillamook, Umatilla, Union, Wallowa, Wasco, and Wheeler
Transcript of HEALTH PLAN OVERVIEW At a glance: 2020 Regence Individual ... · • Pediatric vision is an...
HEALTH PLAN OVERVIEW
DeductibleOut-of-pocket
maximumIn-network copay Coinsurance Rx tiers
In Out In Out Primary Telehealth Secure Chat Specialty Urgent In Out T1 T2 T3 T4 T5 T6
Silver Care on Demand 4000 EPO $4,000* Not covered $8,150* Not covered $0 $0 20% Not covered $15 25% 30% 50% 40% 50%
Bronze Care on Demand 8000 EPO $8,000* Not covered $8,150* Not covered $0 $0 20% Not covered $15 25% 30% 50% 40% 50%
Standard Silver Plan EPO $3,550* Not covered $8,150* Not covered $40 $40 $40 $80 $70 30% Not covered $15 25% $60 50% 40% 50%
Standard Bronze Plan EPO $7,900* Not covered $7,900* Not covered $45 $45 $45 $90 0% Not covered $15 0% 0% 0% 0% 0%
Bronze Essential 7500 EPO $7,500* Not covered $8,150* Not covered $60/x3** $10 $0 $60/x3** $60/x3** 10% Not covered $15 10% 20% 50% 40% 50%
Silver HSA 2700 EPO
Individual $2,700 Not covered $6,900 Not covered 20% Not covered 20% 25% 30% 50% 40% 50%
Family $5,400 Not covered $13,800† Not covered 20% Not covered 20% 25% 30% 50% 40% 50%
Bronze HSA 5200 EPO
Individual $5,200 Not covered $6,900 Not covered 50% Not covered 30% 35% 40% 50% 40% 50%
Family $10,400 Not covered $13,800† Not covered 50% Not covered 30% 35% 40% 50% 40% 50%
†No individual family member pays more than the individual out-of-pocket max.
*Annual individual. Family is 2x the individual.
**Primary, specialty and urgent visits all count toward the combined limit of 3 visits on the Essential plan.
Blue box = Deductible waived
Gray box = Deductible applies
Virtual visits from anywhere 24/7/365• All of our plans cover Doctor On DemandTM, which
lets you access board-certified doctors via the app or video chat.
• Telehealth visits are covered on most plans before you meet your deductible—and cost less than a traditional office visit.
• New! Secure chat with a doctor benefit is available for $0 on most plans. This benefit allows you to connect with a doctor from your phone or the web with a secure chat interface.
Preventive care is covered 100%
• Routine physicals
• Immunizations
• Preventive drugs
• Contraceptives (we cover options in each FDA-approved contraceptive method category at no cost to you, including generics)
Pediatric dental
• Pediatric dental is an essential health benefit and embedded in all non-Standard plans for in-network providers only.
Pediatric vision provided by VSP® Vision Care
• Pediatric vision benefits are administered through VSP.
• You can find VSP Choice providers at regence.com.
• Pediatric vision is an essential health benefit and embedded in all plans for in-network providers only.
Adult dental, vision and IAP buy-up
• Adults can add a product that combines dental, vision and the Individual Assistance Program.
• Vision benefits are administered through VSP® Vision Care. Find VSP Choice providers at regence.com.
• Four counseling sessions per incident and other support services are provided at no member cost.
Pharmacy features & benefits
• MedSavvy®
– Uses medication grades for safety and effectiveness to help you learn about and compare medications.
– Tells you how much a medication costs based on your benefits.
• 90 days of medication at select retail pharmacies or through home delivery (excludes specialty medications).
• $5 off regular copay or 5% regular coinsurance at preferred pharmacies.
• Our HSA plans’ Optimum Value Drug List waives the deductible on listed preventive drugs for cardiovascular disease, high cholesterol, diabetes, osteoporosis, depression and respiratory illness.
At a glance: 2020 Regence Individual plans in Oregon with the Individual and Family Network
Plan availability by countyWe sell these plans to residents of the following counties: Baker, Benton, Clatsop, Columbia, Crook, Deschutes, Gilliam, Grant, Harney, Hood River, Jefferson, Lane, Lincoln, Linn, Malheur, Morrow, Sherman, Tillamook, Umatilla, Union, Wallowa, Wasco, and Wheeler
What’s the Individual and Family Network?
It’s the doctors, facilities and practitioners we’ve contracted with to provide care to our members at a discounted price. It includes providers and facilities in Oregon, as well as providers in Idaho and parts of Utah and Washington.
What happens if you choose an out-of-network provider?
All of our medical plans are Exclusive Provider Organization (EPO) plans, which offer no coverage outside the network (excluding emergency care). To avoid surprise bills, you must be very careful to always see an in-network provider. Find in-network providers at regence.com. And make sure to ask your doctor’s office if they’re specifically in the Individual and Family Network for Regence or call Customer Service at 1-888-REGENCE (734-3623).
What if you’re traveling outside the network service area?
Emergency facilities and ambulances are covered at the in-network cost-share. When you use emergency facilities in the BlueCard® network, you won’t be balance billed.
You also have 24/7/365 in-network access to telehealth through Doctor On Demand, and to urgent care and retail clinics through BlueCard.
Download the Regence app!
The Regence app is available for free for Android and iOS. It gives on-the-go access to a digital member ID card. In addition to seeing claims and benefit information, you can use it to find in-network doctors and estimate costs. Once the app is installed, all that’s needed to sign in is a fingerprint.
Regence complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-344-6347 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-344-6347 (TTY: 711).
Doctor On Demand, MedSavvy and VSP are separate and independent companies that do not provide Blue Cross and Blue Shield products or services, and are solely responsible for their products or services.
Providers in your network are located in these counties
The Individual and Family Network
Hospitals
There are 48 in-network hospitals across Oregon. Use our Find a Doctor tool at regence.com or call Customer Service at 1-888-REGENCE (734-3623).
Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association
Regence BlueCross BlueShield of Oregon 100 SW Market Street | Portland, OR 97201
REG-162362-19/08-OR Indy&Fam © 2019 Regence BlueCross BlueShield of Oregon
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