Selections^® Plus Plan

Boeing Employee Benefits

Higher level of benefits available when you see your Primary Physician or when you call and coordinate your care with a Regence Member Care Coordinator
$10 copay for each outpatient professional visit to a network provider
Benefits for preventive care without copay or coinsurance

Coverage at a Glance

Deductible:	$200 - $500 individual (extended network only)
Annual OOP Max:	$1,000 - $3,000 individual; $2,000 or $4,000 family (extended network only)
Lifetime Max:	$1,500,000 individual
Copay:	$10 office visit; $50 emergency room
Coinsurance:	20% network; 20%; 40% extended network
Network(s):	PPO Network

	Preventive Care
	Hospital Services
	Emergency Room
	Mental Health
	Substance Abuse
	Alternative Care
	Prescription benefits
	Vision
	BlueCard®
	CareEnhance

Basic Features

Deductibles:	$200 - $400 individual (Union) $500 individual (Nonunion) Extended network only No family deductible To learn more about Deductibles, refer to Benefit Summary below.
Annual OOP Max:	$1,000 - $2,000 individual; $2,000 - $4,000 family (Union) $3,000 individual (Nonunion) Extended network only To learn more about Annual OOP Max, refer to Benefit Summary below.
Lifetime Max:	$1,500,000 individual
Coinsurance:	20% network 20%; 40% extended network
Preventive Care:	100% network. No copay required. Not subject to deductible. Extended network care is not covered except for mammograms at 60% and dependent students outside the service area at 80%. Subject to deductible.
Office Visits:	100% network after $10 copay. Not subject to deductible. 60% extended network. Subject to deductible.
Diagnostic x-ray and Laboratory Services:	100% network. Not subject to deductible. 60% extended network. Subject to deductible.
Hospital Services:	100% network. Not subject to deductible. 60% extended network. Subject to deductible.
Emergency Room:	100% network and extended network after $50 copay Not subject to deductible Emergency room treatment is paid at the network level when the condition meets the definition of a medical emergency. Refer to the Guide to Benefits below for more information.
Mental Health:	Inpatient: 100% network (limited to 30 days per benefit year and not subject to deductible); 50% extended network (limited to 30 days per benefit year and subject to deductible) Outpatient: 100% network (limited to 30 visits per benefit year and not subject to deductible); 50% extended network (limited to 30 visits per benefit year and subject to deductible) To receive benefits for mental health treatment, you must contact the Boeing Helpline (ValueOptions) at 1 (800) 892-1411.
Substance Abuse:	Inpatient: 100% network (not subject to deductible); 50% extended network (subject to deductible) Outpatient: 100% network after $10 copay (not subject to deductible); 50% extended network (subject to deductible) To receive benefits for substance abuse treatment, you must contact the Boeing Helpline (ValueOptions) at 1 (800) 892-1411.
Alternative care:	100% network after $10 copay. Not subject to deductible. 60% extended network. Subject to deductible. Limited to a combined total of 26 spinal and extremity manipulation visits per benefit year. Limited 12 acupuncture visits per benefit year. Alternative care includes services received by acupuncturists, chiropractors, massage therapists, naturopaths, and nutritionists.
Prescriptions:	Generic: $5 retail copay; $10 mail-order copay Brand-name formulary: $15 retail copay; $30 mail-order copay Non-formulary: $30 retail copay; $60 mail-order Not subject to deductible Prescription medications are covered through a prescription program managed by RegenceRx. Visit the RegenceRx Web site to learn more.
Vision:	100% network after $10 copay. One exam per benefit year. Not subject to deductible. Extended network exams are not covered Two pairs of lenses and frames, or contact lenses every two benefit years

Benefit Summary

To view, save, or print a copy of the Benefit Summary, you will require Adobe® Acrobat® Reader. If you do not have Acrobat® Reader, you can download a free copy from Adobe®.

Guide to Benefits

To view, save, or print a copy of the Guide to Benefits booklet, you will require Adobe® Acrobat® Reader. If you do not have Acrobat® Reader, you can download a free copy from Adobe®.

If you would like a hard copy of the Guide to Benefits booklet mailed to you, use the secure Request Information form or contact Regence Boeing Customer Service at 1 (800) 422-7713.

This information is provided as confirmation of benefits available under the Selections Plus Plan for Boeing employees, early retirees, and their families and should not be construed as a guarantee of coverage for any services. The final determination on all claims is made upon their submittal to the plan.

Selections® Plus Plan