Regence HSA Healthplan - $2,500 Individual Deductible

HSA Oregon

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, 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: $2,500 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 for participating providers, no maximum for non-participating providers
Lifetime Max:	$2 million per member
Copay:	Not applicable on this plan
Coinsurance:	20% participating provider, 40% non-participating
Coinsurance Max:	Not applicable on this plan
Network(s):	Participating Network Find a Doctor

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

Basic Features

Cost Sharing
Deductibles:	$2,500 per member
Annual OOP Max:	$5,000 per member for participating providers Amount includes deductible No maximum for non-participating providers
Coinsurance Max:	Not applicable on this plan
Lifetime Max:	$2 million paid by Regence per member
Copay:	Not applicable on this plan
Coinsurance:	You pay 20% when using participating providers You pay 40% when using non-participating providers

Everyday Needs
Prescriptions:	You pay 50% when using participating and non-participating pharmacies You pay 20% for self-administered chemotherapy medications Subject to deductible
Preventive Care:	You pay 20% when using participating providers You pay 40% when using non-participating 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:	Not covered
Maternity:	Deductible and coinsurance
Mental Health:	Not covered

Other considerations
Network(s):	Participating Network
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

Rates

Fourth quarter rates are effective 10/1/2009 through 12/31/2009.

First quarter rates are effective 1/1/2010 through 3/31/2009.

Optional Benefits

Complete your health plan with Dental coverage: Individual Dentacare

No deductibles, no annual maximums
$15 per visit copay for basic dental services

Learn more about Individual Dentacare »

Medical Exclusions and Limitations

Acupuncture	Not covered
Alcoholism	Limited to $4,500 in any 24-month period
Ambulance	$5,000 per calendar year, ground and air
Cosmetic/Reconstructive Surgery	Not covered
Custodial Care and Rest Cures	Not covered
Dental Injury	$1,000 per calendar year
Drug Abuse/Addiction Treatment	Not covered
Durable Medical Equipment	$2,500 per calendar year. No limit for prosthetics and orthotic devices.
Family Planning	Not covered
Growth Hormone Benefit	$20,000 per calendar year; must be preauthorized
Hearing Aids	Not covered
Home Health Care	130 visits per calendar year
Mental Health Treatment	Not covered
Obesity or Weight Control	Not covered
Orthognathic Surgery	Not covered
Outpatient Counseling	Not covered
Preventive Care	Not limited
Rehabilitative Care (inpatient)	$15,000 per calendar year
Rehabilitative Care (outpatient)	$1,500 per calendar year
Skilled Nursing Facility	100 days per stay
Spinal Manipulation	Not covered
Temporomandibular Joint Disorder	$1,000 per calendar year
Transplants	$250,000 lifetime maximum 24-month waiting period
Tobacco Addiction Treatment	Not covered

You must be covered for at least 12 months before we pay for any of the following
Allergies	12-month waiting period
Sterilization	12-month waiting period
Elective Procedures	12-month waiting period

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.