Regence HSA Healthplan - $3,500 Individual Deductible

Idaho Heath Plans| HSA Healthplan $3,500 Individual Deductible

Own your health care dollars with a tax-advantaged account that covers medical expenses beyond your health plan. Or choose to save.
Unlimited, up-front preventive care and wellness programs, plus personalized tools and support you need to make the plan your own.
Comprehensive wellness programs like Care Enhance^® Nurseline & Regence Health Coach^SM.

Coverage at a Glance

Deductible:	Selected: $3,500 Individual $1,500 Individual $2,500 Individual $3,500 Individual $3,000 Family $5,000 Family $7,000 Family
Annual OOP Max:	$5,000 per member
Lifetime Max:	$2 million per member
Copay:	Emergency Room Only
Coinsurance:	20% preferred providers, 40% non-preferred
Coinsurance Max:	Not applicable on this plan
Network(s):	Regence PPO Network Find a Doctor

	Prescription benefits
	Dental
	Vision
	No Referrals
	Maternity
	Preventive Care
	Alternative Care
	Mental Health

Basic Features

Cost Sharing
Deductibles:	$3,500 per member
Annual OOP Max:	$5,000 per member
Coinsurance Max:	Not applicable on this plan
Lifetime Max:	$2 million paid by Regence per member
Copay:	$50 emergency room copay
Coinsurance:	You pay 20% when using preferred providers You pay 40% when using non-preferred providers

Everyday Needs
Prescriptions:	You pay 50% at participating and non-participating pharmacies Limited to a 30-day supply at a time, or a 90-day supply using mail-order program Limited to $1,200 per calendar year Subject to deductible
Preventive Care:	You pay 20% when using preferred providers You pay 40% when using non-preferred providers No deductible No annual limit
Vision:	Not covered
Office Visits:	Deductible and coinsurance
Diagnostic x-ray services:	Deductible and coinsurance
Outpatient Laboratory services:	Deductible and coinsurance

Special Needs
Alternative care:	Chiropractic services only Deductible and coinsurance Limited to $500 per calendar year
Maternity:	Not covered
Mental Health:	You pay 50% when using preferred or non-preferred providers Limited to 20 outpatient visits and 8 inpatient days Includes chemical dependency treatment

Other considerations
Network(s):	Regence PPO (Preferred)
Banking:	A financial institution provides the account where you save money for "qualified medical expenses" as defined by the IRS. We have preferred banking partners that offer some advantages, but you're free to use any institution that provides HSAs. HSA Bank Wells Fargo

Benefit Summary

PDF (91k) Benefit Summary: Regence HSA Healthplan $3,500 Individual

Rates

First quarter rates are effective 1/1/2010 through 3/31/2010.

Medical Exclusions and Limitations

Alcoholism and Chemical Dependency	See Mental Health
Alternative Care	Only covers chiropractic $500 calendar year maximum
Cosmetic OR Reconstructive Surgery	Excluded
Custodial Care and Rest Cures	Excluded
Diabetic Education	Excluded
Durable Medical Equipment	Not limited
Eye Exams and Hardware	Excluded
Experimental/Investigational	Excluded
Family Planning	Excluded
Foot Care	Excluded
Hearing Aids	Excluded
Home Health Care	$5,000 calendar year maximum
Hospice	$5,000 lifetime maximum
Human Growth Hormone Therapy	$25,000 calendar year maximum
Labs and X-rays	Not limited
Maternity Care	Excluded
Mental Health Treatment	Inpatient: 8 days calendar year maximum Outpatient: 20 visits calendar year maximum
Medically Unnecessary Services	Excluded
Obesity or Weight Control	Excluded
Physician Office Visits	Not limited
Prescription medications	Limited to $1,200 calendar year maximum for generic and brand medications
Rehabilitative Care (inpatient)	$15,000 calendar year maximum
Rehabilitative Care (outpatient)	$800 calendar year maximum per therapy: Occupational Therapy Physical Therapy Respiratory Therapy Speech Therapy
Skilled Nursing Facility	30 days calendar year maximum
TMJ Disorder and Orthognathic Surgery	$2,000 lifetime maximum
Transplants	$250,000 lifetime maximum

Occupational Therapy
Physical Therapy	Not limited
Respiratory Therapy	Not limited

Preventative Care
Lab and x-ray	Not limited
Routine Baby and Child Care	Excluded
Routine Immunizations	Not limited
Routine Physical Exams	Not limited

This does not include all benefits, limitations, exclusions and other terms of coverage (such as eligibility and cancellation provisions) applicable to this plan. Please refer to your contract of a complete list and more in-depth explanation of benefits and the limitations and exclusions that apply.