Regence NowSelect^SM $7500

Idaho Health Plans | NowSelect Plan - $7,500 Deductible

A limited health plan that includes six office visits.
Preventive care has a $300 limit per calendar year that applies to an exam, routine lab and x-ray services.
Prescriptions include unlimited generics and up to $1,200 for brand medications.

Coverage at a Glance

Deductible:	Selected Deductible: $7,500 $1,000 $2,500 $5,000 $7,500
Annual OOP Max:	Not applicable on this plan
Lifetime Max:	$2 million per member
Copay:	$25
Coinsurance:	20% preferred providers, 50% non-preferred
Coinsurance Max:	$2,500 per member
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:	$7,500 per member Family maximum of two individual deductibles
Annual OOP Max:	Not applicable on this plan
Coinsurance Max:	You pay $0 after reaching $2,500 coinsurance maximum per member Family coinsurance maximum of three individual maximums
Lifetime Max:	$2 million paid by Regence per member
Copay:	You pay $25 when using preferred or non-preferred providers
Coinsurance:	You pay 20% when using preferred providers You pay 50% when using non-preferred providers

Everyday Needs
Prescriptions:	$10 copay (no limits) for generic medications purchased at the pharmacy You pay 50% for all brand medications Mail order available No deductible Brand medications limited to $1,200 per calendar year
Preventive Care:	You pay $25 copay for office visit (any provider) No deductible $300 limit per calendar year applies to an exam, routine lab and x-ray services
Vision:	Not covered
Office Visits:	You pay $25 copay using preferred or non-preferred providers Limited to six visits per calendar year No deductible
Diagnostic x-ray services:	Deductible and coinsurance Limited to $2,500 per calendar year for services outside of inpatient setting (limit combined with lab services)
Outpatient Laboratory services:	Deductible and coinsurance Limited to $2,500 per calendar year for services outside of inpatient setting (limit combined with x-ray)

Special Needs
Alternative care:	Not covered
Maternity:	Separate $5,000 deductible Coinsurance
Mental Health:	Not covered

Other considerations
Network(s):	Preferred Providers Regence PPO Network Non-Preferred Providers Providers outside of the Regence PPO Network

Benefit Summary

PDF (100k) Benefit Summary: Regence NowSelect - $7,500 Deductible

Rates

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

Medical Exclusions and Limitations

Alcoholism and Chemical Dependency	Excluded
Alternative Care	Excluded
Cosmetic OR Reconstructive Surgery	Excluded
Custodial Care and Rest Cures	Excluded
Diabetic Education	$400 calendar year maximum
Durable Medical Equipment	Excluded
Eye Exams and Hardware	Excluded
Experimental/Investigational	Excluded
Family Planning	Excluded except for oral contraceptives
Foot Care	Excluded
Hearing Aids	Excluded
Home Health Care	Excluded
Hospice	Excluded
Human Growth Hormone Therapy	Excluded
Labs and X-rays	$2,500 calendar year maximum, outpatient only
Maternity Care	Separate $5,000 deductible
Mental Health Treatment	Excluded
Medically Unnecessary Services	Excluded
Obesity or Weight Control	Excluded
Physician Office Visits	6 visits calendar year maximum
Prescription medications	Generic: Unlimited Brand Medications: $1,200 calendar year maximum
Rehabilitative Care (inpatient)	Excluded
Rehabilitative Care (outpatient)	Excluded: Occupational Therapy Physical Therapy Respiratory Therapy Speech Therapy
Skilled Nursing Facility	30 days calendar year maximum
TMJ Disorder and Orthognathic Surgery	Excluded
Transplants	$250,000 lifetime maximum

Occupational Therapy
Physical Therapy	Excluded
Respiratory Therapy	Excluded

Preventative Care
Lab and x-ray	$2,500 calendar year maximum, outpatient only
Routine Baby and Child Care	$300 per member per calendar year maximum
Routine Immunizations	No limit
Routine Physical Exams	$300 calendar year maximum (except routine gynecology exams, pap smears, and mammography)

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.

Regence NowSelectSM $7500