Regence HSA Healthplan - $7,000 Family Deductible

Individual Health Insurance Utah

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: $7,000 Family $1,500 Individual $2,500 Individual $3,500 Individual $3,000 Family $5,000 Family $7,000 Family
Annual OOP Max:	$10,000 per family
Lifetime Max:	$2 million per member
Copay:	Not applicable on this plan
Coinsurance:	20% In-Network, 40% Out-of-Network
Coinsurance Max:	Not applicable on this plan
Network(s):	Regence Traditional/ValueCare Find a Doctor

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

Basic Features

Cost Sharing
Deductibles:	$7,000 Family
Annual OOP Max:	$10,000 family Amount includes your deductible Maximum applies to in-network services only. No maximum for out-of-network services.
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% for most in-network services. You pay 40% for most out-of-network services.

Everyday Needs
Prescriptions:	You pay 50% at in-network and out-of-network pharmacies. Subject to deductible
Preventive Care:	You pay 20% for in-network providers. You pay 40% for out-of-network providers. Deductible waived No annual limit
Vision:	Not covered
Office Visits:	Deductible and coinsurance apply
Diagnostic x-ray services:	Deductible and coinsurance apply
Outpatient Laboratory services:	Deductible and coinsurance apply

Special Needs
Alternative care:	Not covered
Maternity:	Not covered
Mental Health:	$1,500 limit per calendar year

Other considerations
Network(s):	Traditional (Regence BlueCross BlueShield of Utah) Network ValueCare 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

Benefit Summary

PDF (46k) Benefit Summary: $3,500 Single/$7,000 Family Deductible

Rates

Rates for all Individual and Family plans will change effective July 1, 2009.

About rate changes: We typically adjust rates once a year in July, but the state legislature may mandate changes that affect the cost at other times of the year. Your rate may be adjusted at those times, even if you enrolled for coverage in the previous month.

Medical Exclusions and Limitations

DOC (44k) Regence HSA Healthplan Exclusions & Limitations

Alternative Care	Excluded
Birth Control	Included (except for non-prescription contraceptives)
Cosmetic OR Reconstructive Surgery	Excluded
Counseling	Excluded
Custodial Convalescent Cures	Excluded
Dental Services	Excluded (accidental injury to sound natural teeth is covered)
Durable Medical Equipment	$2,500 limit per enrollee per calendar year
Erectile Dysfunction	Excluded
Foot Care	Excluded
Gastric Procedures such as gastric bypass	Excluded
Genetic Services	Excluded
Growth Hormone Benefit	$20,000 limit per enrollee per calendar year
Hearing Treatment	Excluded
Home Health Care	130 visits per enrollee per calendar year
Infertility	Excluded
Maternity Care	Excluded
Mental Health Treatment	$1,500 limit per enrollee per calendar year
Obesity or Weight Control	Excluded
Orthognatic Surgery	Excluded
Pre-existing conditions	12-month waiting period
Rehabilitative Care (inpatient)	$4,000 limit per enrollee per calendar year
Rehabilitative Care (outpatient)	$2,000 limit per enrollee per calendar year
Sterilization	12-month waiting period
Temporomandibular Joint Disorder	Excluded
Transplants	Limited to $250,000 per person per lifetime
Tobacco Addiction Treatment	Excluded
Vision	Excluded

You must be continuously covered for at least 12 months before we pay for any of the following
Pre-existing conditions	12-month waiting period
Sterilization	12-month waiting period

Preventative Care
Children — first 24 months	No annual limitations
Children — age 2—5	No annual limitations
Children — ages 6 and older	No annual limitations
Adult men and women	No annual limitations

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.