Washington Protection Plus - $5,000

Idaho Health Plans | Washington Protection Plus - $5,000 Deductible

Coinsurance: you pay 20% for most services after exhausting your deductible; we cover the rest.
Vision care: includes one eye exam every 12 months.
Lifetime maximum: covers up to $1 million in health care expenses.

Coverage at a Glance

Deductible:	Selected Deductible: $5,000 $750 $5,000
Annual OOP Max:	Not applicable on this plan
Lifetime Max:	$1 million per member
Copay:	Emergency room only
Coinsurance:	20% for any provider
Coinsurance Max:	Not applicable on this plan
Network(s):	No network restrictions Find a Doctor

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

Basic Features

Cost Sharing
Deductibles:	$5,000 per member Family maximum of two individual deductibles
Annual OOP Max:	Not applicable on this plan
Coinsurance Max:	Not applicable on this plan
Lifetime Max:	$1 million paid by Regence per member
Copay:	$50 copay for emergency room only
Coinsurance:	You pay 0% for participating provider You pay 20% coinsurance for non-participating provider

Everyday Needs
Prescriptions:	Deductible only No coinsurance required
Preventive Care:	Mammography and prostate cancer screenings only Deductible and coinsurance
Vision:	Deductible and coinsurance One eye exam every 12 months
Office Visits:	Deductible and coinsurance
Diagnostic x-ray services:	Deductible and coinsurance
Outpatient Laboratory services:	Deductible and coinsurance

Special Needs
Alternative care:	Covers chiropractic, naturopathic, acupuncture, dietician, and massage therapy Deductible and coinsurance
Maternity:	Deductible and coinsurance
Mental Health:	Deductible and coinsurance Inpatient limited to $10,000 in 24 months; $30,000 lifetime maximum Outpatient limited to $500 per calendar year

Other considerations
Network(s):	No network restrictions

Benefit Summary

PDF (87k) Benefit Summary: Washington Protection Plus $5,000 Deductible

Rates

PDF (14k) Rates: Washington Protection Plus

Medical Exclusions and Limitations

Alternative Care	Not limited Includes acupuncture, chiropractic, naturopathic, and massage therapy
Chemical Dependency Treatment	Limited to $10,000 during 24 consecutive months
Custodial Care and Rest Cures	Not covered
Diabetic Education	Not limited
Durable Medical Equipment	Not limited
Eye Exams and Hardware	Limited to one eye exam per calendar year Hardware not covered (including frames, lenses, and contacts)
Experimental/Investigational	Not covered
Family Planning	Not limited; such as infertility treatment, surrogate pregnacy, etc. (except sterilization)
Foot Care	Not covered
Hearing Aids	Not covered
Home Health Care	Limited to 130 visits per calendar year
Hospice	Limited to 6 months
Human Growth Hormone Therapy	Requires preauthorization
Labs and X-rays	Not limited; outpatient only
Maternity Care	Not limited; includes prenatal, delivery, and routine newborn care (not included for dependent children)
Mental Health Treatment	Inpatient: Limited to $10,000 during 24 consecutive months; $30,000 lifetime maximum Outpatient: Limited to $500 per calendar year
Medically Unnecessary Services	Not covered
Obesity or Weight Control	Not covered
Physician Office Visits	Not limited
Prescription medications	Generic: Not limited Brand Medications: Not limited
Rehabilitative Care (inpatient)	Limited to $15,000 per calendar year
Rehabilitative Care (outpatient)	Limited to $1,000 per calendar year for all therapies combined: Occupational Therapy Physical Therapy Respiratory Therapy Speech Therapy
Skilled Nursing Facility	Limited to 30 days
Temporomandibular Joint Disorder	$2,000 lifetime maximum
Transplants	Limited to $150,000 per lifetime
Tobacco Addiction Treatment	Not covered

Occupational Therapy
Physical Therapy	Limited (see above)
Respiratory Therapy	Limited (see above)

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

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.