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Plan Information

Regence InnovaSM in Oregon

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Unique Features

At a Glance

Type of Plan: Health-Focused

IncludedAlternative care
IncludedMaternity
IncludedMental Health
IncludedNo Referrals
IncludedUnlimited Office Visits
IncludedPrescriptions
IncludedPreventive Care
IncludedWellness Programs

Deductible: $250 - $7,500 individual
Annual Max: $2,000,000
Coinsurance Max: $2,000-$6,000 individual
Copay: $20 - $55
Coinsurance: 90% - 50%
Providers: Category 1, 2 and 3

Network Options

Plan Highlights

View Clark Co., WA »Oregon

Effective date January 1, 2013 and Beyond
PDF Icon Regence Innova Plan Highlights (PDF)

Effective date January 1, 2012 to December 31, 2012
PDF Icon Regence Innova Plan Highlights (PDF)

Pharmacy Benefits

Pharmacy benefits are a standard part of the Innova plan design with four options to choose from.

Package Options

Option 1

Option 2

Option 3

Option 4

Generic (not subject to deductible)

$5 copay

$7 copay

$10 copay

$10 copay

Brand (formulary)

$25 copay

25% coinsurance

35% coinsurance

$35 copay

Brand (non-formulary)

$50 copay

50% coinsurance

50% coinsurance

$75 copay
Out-of-Pocket Maximum* $3,000 $4,000 $5,000
no out-of-pocket-maximum

*Copays and coinsurance apply to the out-of-pocket maximum. Effective 1/1/08: Copays for self-administered chemotherapy medication, including oral (all options): $10 generic/$50 brand-name formulary/$100 brand-name non-formulary (not subject to prescription medication deductible or out-of-pocket maximum).

If an equivalent generic medication is available and a brand-name medication is chosen, the member is responsible for paying the applicable brand-name copay/coinsurance plus the difference in price between the equivalent generic medication and the brand-name medication not to exceed total retail cost.

Copays for self-administered chemotherapy medication, including oral (all options): $10 generic/$50 brand name formulary/$100 brand-name nonformulary (not subject to prescription medication deductible)

Additional Options

Brand Deductible** (optional)

$250 deductible (brand formulary/non-formulary)

$500 deductible (brand formulary/non-formulary)

**Brand deductible does not accrue to the member's out-of-pocket maximum.

Wellness Programs

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.

24-Hour Nurse Line®

A 24-hour nurse hotline staffed by registered nurses. It's 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 Advantages

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

Optional Benefits

You can round out the benefits 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.

Employee Assistance Program (EAP) 
  • 24-hour crisis assistance
  • up to 4 face-to-face counseling sessions per incident
  • Legal and financial services
  • read more

Exclusions and Limitations to Coverage

These exclusions apply to the medical plans only and do not apply to the wellness programs.

Preventive care

Preventive services and immunizations are covered according to guidelines set forth by the United States Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA).

Waiting Periods

No benefits are provided for treatment relating to a transplant until the member has been covered under this or a prior plan for 24 consecutive months. There is a six-month waiting period that must be met prior to benefits being available for pre-existing conditions. Members may receive credit from prior medical coverage. Pre-existing condition waiting periods do not apply to Members up to age 19.

Outside the Service Area

Members have the security of knowing they can access Blue Cross and/or Blue Shield (Blue Plan) providers across the country and worldwide through the BlueCard® Program. Plan benefits apply as described above, and members may receive discounts on their services.

General Medical Exclusions

Coverage is not provided for any of the following, including direct complications or consequences that arise 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 and 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 governmental program
  • Infertility except to the extent covered services are required to diagnose 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-Direct Patient Care including appointments scheduled and not kept, charges for preparing medical reports, itemized bills or claim forms, and visits or consultations that are not in person, including telephone consultations and email exchanges
  • 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 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 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 and 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 Liability: Services and supplies for treatment of illness or injury for which a third party is or may be responsible
  • Travel and Transportation Expenses other than covered ambulance services
  • Work-Related Conditions except for subscribers who are owners, partners, or corporate officers and are exempt from state or federal workers' 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.
 

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Availability

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Available to groups of all sizes.

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Consumer Directed Health Programs

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