• Members can choose from one of the following five Patient Choice Networks: Oregon Select Providence, Oregon Select OHSU, Oregon Select Legacy Health, Oregon Select Tuality or Oregon Select Adventist Health.
• Up-front coverage for immediate access to care
• Personalized wellness programs encourage and reward the insured for reaching their health goals
• MyDecision^SM features give your employees the choices they want and the tools they need to manage their health

Effective date August 1, 2011 and beyond

Summary of Benefits (PDF): Regence Blue Value Plan Highlights

Our health-focused plans come with comprehensive wellness resources. These programs are not insurance, but they are offered in addition to your medical plan to help your employees get information and support when they need it.

Integrated Care Management

Integrated Care Management provides specialized, targeted attention and support for employees who need assistance in managing their care. A Personal Care Team of clinical experts is ready to assist employees and their families with an ongoing medical condition, or serious illness or injury. The program provides easy access to one-on-one support focused on closing care gaps. Learn more about the program.

CareEnhance^®

A 24-hour nurse hotline staffed by registered nurses. CareEnhance is a great way for members to get medical questions answered without having to make an appointment with a doctor or visit an urgent care clinic. By explaining symptoms or concerns, members can get advice on what they can do on their own—or get a nurse’s opinion on whether they should see a doctor right away.

Regence Rare Disease Condition Management Program

The Regence Rare Disease Condition Management Program, in collaboration with Accordant®, is a valuable service that provides a personal health care support system to members with rare, complex, chronic conditions. Members who are affected by select conditions have 24/7 access to specially trained nurses who can answer questions and make recommendations for care.

This program is designed to meet unique health care needs and help coordinate care by working with you, your doctors and designated family members to obtain the best possible care in the most efficient manner.

Regence Advantages

Members-only discount program offers your employees savings from a number of nationally recognized, health-related companis. Learn more about Regence Advantages.

You can round out the benefits your employees will enjoy by adding optional plan benefits.

Complementary Care

Combined naturopathic, chiropractic, and acupuncture services and supplies limited to 8 or 24 visits per calendar year.

• Not subject to deductible or coinsurance max., paid at 80%

Vision

• 100% coverage for annual eye exam (Category 1 & 2, Category 3 may be subject to balance billing)
• Not subject to deductible
• Up to $150 in hardware annually

Dental Options

Three plans that offer something for everyone. Available as stand-alone, or paired with Blue Value.

• Dental Plan Information:

Employee Assistance Program (EAP) 

• 24-hour crisis assistance
• up to 4 face-to-face counseling sessions per incident
• Legal and financial services
• read more

General Medical Exclusions

Coverage is not provided for any of the following, including direct complications or consequences that are from:

• Cosmetic/Reconstructive Services and Supplies except for reconstruction for functional injury and disease, to treat a congenital anomaly for members up to age 18, and for breast reconstruction following a medically necessary mastectomy to the extent required by law.
• Counseling: in the absence of illness
• Custodial Care: Non-skilled care, helping with activities of daily living.
• Dental Examinations and Treatments.
• Fees, Taxes, Interest: Charges for shipping and handling, postage, interest, or finance charges that a provider might bill.
• Government Programs: Benefits that are covered, or would be covered in the absence of this plan, by any federal, state or government program.
• Infertility: Except to the extent covered services are required to diagnosis such condition.
• Investigational Services: Treatment or procedures (health interventions) and services, supplies, and accommodations provided in connection with investigational treatments or procedures.
• Medications without a Prescription Order
• Military Service Related Conditions: The treatment of any condition caused by or arising out of a member's active participation in a war or insurrection or conditions incurred in or aggravated during performance in the Uniformed Services.
• Motor Vehicle Coverage and Other Insurance Liability
• Non-Duplication of Medicare: Services and supplies to the extent payable under Medicare, when by law, the plan would not be primary to Medicare had the member properly enrolled in Medicare when first eligible regardless of whether or not the member actually enrolled.
• Obesity or Weight Reduction/Control: Medical treatment, medication, surgical treatment (including reversals, programs or supplies that are intended to result in or relate to weight reduction, regardless of diagnosis.
• Orthognathic Surgery: Except for congenital conditions, temporomandibular joint disorder, injury, and sleep apnea.
• Personal Comfort Items: Items that are primarily for comfort, convenience, cosmetics, environmental control or education.
• Physical Exercise Programs and Equipment: Including hot tubs, or membership fees at spas, health clubs, or other such facilities; applies even if the program, equipment, or membership is recommended by the member's provider.
• Private Duty Nursing: Including ongoing shift care in the home.
• Riot, Rebellion, War and Illegal Acts: Services and supplies for treatment of an illness, injury, or condition caused by a member's voluntary participation in a riot, armed invasion, or aggression, insurrection, or rebellion or sustained by a member while committing an illegal act or felony.
• Routine Foot Care: Including treatment of corns, calluses, and trimming of nails.
• Routine Hearing Exams
• Self-help, Self-care, Training or Instructional Programs: Including childbirth classes, diet and weight monitoring services and instruction programs, including those programs that teach a person how to use durable medical equipment or how to care for a family member.
• Services and Supplies Provided by a Member of Your Family
• Services and Supplies That are not Medically Necessary
• Services to Alter Refractive Character of the Eye
• Sexual Reassignment Treatment and Surgery: Treatment, surgery, and counseling services for sexual reassignment.
• Sexual Dysfunction: Regardless of cause, except for counseling provided by covered, licensed mental health practitioners.
• Third Party Coverage: Services and supplies for treatment of illness or injury for which a third party is responsible.
• Travel and Transportation Expenses: Other than Ambulance Services
• Work-Related Conditions: Except for subscribers who are owners, partners, or corporate officers and are exempt from state or federal worker's compensation law.

This is a brief summary of benefits; it is not a certificate of coverage. All benefits must be medically necessary. For full coverage provisions, refer to the contract.