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Regence SummitSM $7,500

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

    • Alternative care covers acupuncture, naturopathy, chiropractic, and massage therapy.
    • No limits for office visits, preventive care, and generic medications.
    • Vision care: 100% coverage for annual exam, plus up to $100 for glasses and/or contacts.
     

Coverage at a Glance


Deductible:
Annual OOP Max: Not applicable on this plan
Lifetime Max: $2 million per member
Copay: $20
Coinsurance: 20% preferred providers, 40% non-preferred
Coinsurance Max: $2,000 per member
Network(s): Regence PPO Network

Find a Doctor
 
Yes Prescription benefits
No Dental
Yes Vision
Yes No Referrals
Yes Maternity
Yes Preventive Care
Yes Alternative Care
Yes 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 $2,000 coinsurance maximum per member, per calendar year
  • Family coinsurance maximum of three individual maximums
Lifetime Max: $2 million paid by Regence per member
Copay: You pay $20 when using preferred or non-preferred providers
Coinsurance:
  • You pay 20% when using preferred providers
  • You pay 40% 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 $2,000 per calendar year
 
Preventive Care:
  • You pay $20 copay for office visit (any provider)
  • No deductible
  • You pay coinsurance for routine lab and x-ray, no deductible
  • No limits per calendar year
Vision:
  • You pay $0 for one routine eye exam per calendar year
  • You pay $0 for glasses and/or contacts up to $100 per year
Office Visits:
  • You pay $20 copay using preferred or non-preferred providers
  • No deductible
Diagnostic x-ray services: Deductible and coinsurance
Outpatient Laboratory services: Deductible and coinsurance
Special Needs
Alternative care:
  • Covers chiropractic, naturopathic, acupuncture, and massage therapy
  • Deductible and coinsurance
  • $500 limit for all services combined per calendar year
Maternity:
  • Separate $5,000 deductible
  • Coinsurance
Mental Health:
  • Deductible and 50% coinsurance
  • Includes chemical dependency treatment
  • $1,500 limit per calendar year
Other considerations
Network(s):

Preferred Providers

  • Regence PPO Network

Non-Preferred Providers

  • Providers outside of the Regence PPO Network

Benefit Summary

Rates

Idaho Medical Insurance | Individual & Family Plans
Idaho Individual & Family Plans

Idaho Medical Insurance | Individual & Family Plans

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Regence HSA Healthplan

Brings together robust preventive care benefits and protection against the unexpected, with the unique power of a tax-advantaged Health Savings Account. For individuals and families.

Regence SummitSM

For the mindful health consumer, Regence Summit is the plan that meets the need for freedom of choice and financial/asset protection. For individuals and families.

Regence NowSelectSM

A low-cost, limited health plan you can use right away. For individuals and families.

InterMSM

Temporary medical coverage for unexpected accidents and illnesses, offered through our affiliate Regence Life and Health. Good for individuals and families who are between jobs, or waiting for an employer plan to start. There are restrictions on pre-existing conditions, so please check the details carefully.

Individual Dollar-Based Dental

A Dental plan that puts you in control of your dental health dollars, offered through our affiliate Regence Life and Health. This plan is dollar-based -a unique departure from traditional procedure-based coverage. Imagine spending your benefit dollars almost any way you choose, on care that's important to you and your family. Each year you decide to include an exam and cleaning, you are rewarded with a benefit increase the following year.

Individual Incentive Dental

Immediate access to quality, affordable dental care, offered through our affiliate Regence Life and Health. This plan is procedure-based, but unlike traditional dental plans you are rewarded for receiving routine preventive care. Each year that you visit the dentist for a checkup and cleaning, means greater benefits and less out-of-pocket expenses the next year.

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

Medical Exclusions and Limitations

Alcoholism and Chemical Dependency Limited to $1,500 per calendar year
Alternative Care $500 calendar year maximum for all combined
Cosmetic OR Reconstructive Surgery Excluded, except as specified by law
Custodial Care and Rest Cures Excluded
Diabetic Education $400 calendar year maximum
Durable Medical Equipment Not limited
Eye Exams and Hardware One exam and $100 for hardware each calendar year
Experimental/Investigational Excluded
Family Planning Excluded except oral contraceptives and contraceptive devices
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 Separate $5,000 deductible
Mental Health Treatment $1,500 calendar year maximum for inpatient and outpatient combined
Medically Unnecessary Services Excluded
Obesity or Weight Control Excluded
Physician Office Visits Not limited
Prescription medications
  • Generic: Unlimited
  • Brand Medications: $2,000 calendar year maximum
Rehabilitative Care (inpatient) Not limited
Rehabilitative Care (outpatient) $800 per 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 Limited to $800 per calendar year
Respiratory Therapy Limited to $800 per calendar year
Preventative Care
Lab and x-ray Not limited
Routine Baby and Child Care Not limited
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.

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