• Provide your employees with a choice. You choose how many plans to offer from the eight plan designs available.
• Up-front coverage for immediate access to care.
• Personalized wellness programs encourage and reward the insured for reaching their health goals.
• Enhanced support and interactive tools make this plan easy to understand and use.

With Employee Choice, you can choose one of the following network options to apply to all product configurations offered:

• Oregon Select Adventist
• Oregon Select Tuality
• Preferred (PPO)

To receive Category 1 benefits, members must see a provider in the selected network.

Benefit Summaries effective 01/01/2012

Innova

• Innova $500
• Innova $1,000
• Innova $1,500
• Innova $2,000
• Innova $3,000

These benefit summaries have been generated using one of the 12 RX configurations available with Innova plans in Employee Choice ($10/$35/$75 with no OOP Max and $0 Brand Rx deductible.) A different RX option may be selected from the 12 available, but whichever option you choose must apply to all the Innova plan configurations offered.

Regence HSA Healthplan 2.0

• Regence HSA Healthplan 2.0 $2,500
• Regence HSA Healthplan 2.0 $3,000
• Regence HSA Healthplan 2.0 $5,000

If an Innova plan is selected as one of your plan choices, pharmacy benefits are included. You can choose one of the following 12 different options and it will apply to all selected Innova plan configurations:

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.

Unlimited Spinal Manipulations

• No benefit maximum
• Category 1 & 2, Category 3 maybe be subject to balance billing

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. Choose one to apply to all Employee Choice plan configurations.

• 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.