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Preferred PPO Catastrophic - $1,750 Deductible

Washington Health Plans | Preferred PPO Catastrophic - $1,750 Deductible

    • No-frills: covers just the basics to keep your rates affordable.
    • Coinsurance: 20% for preferred providers, up to a $3,500 maximum. Then we cover the rest.
    • Lifetime maximum coverage: up to $1 million in health care expenses.

Coverage at a Glance


Deductible: $1,750
Annual OOP Max: Not applicable on this plan
Lifetime Max: $1 million per member
Copay: Not applicable on this plan
Coinsurance: 20% preferred providers, 50% participating
Coinsurance Max: $3,500 per member
Network(s): Preferred Providers

Find a Doctor
No Prescription benefits
No Dental
No Vision
Yes No Referrals
No Maternity
No Preventive Care
Yes Alternative Care
Yes Mental Health
 

Basic Features

Cost Sharing
Deductibles:
  • $1,750 per member
  • Family maximum of three individual deductibles
Annual OOP Max:

Not applicable on this plan
Coinsurance Max:
  • You pay $0 after reaching $3,500 coinsurance maximum per member using preferred providers
  • Family coinsurance maximum of three individual maximums
  • No maximum when using participating providers
Lifetime Max: $1 million paid by Regence per member
Copay:

Not available on this plan
Coinsurance:
  • You pay 20% when using preferred providers
  • You pay 50% when using participating providers
Everyday Needs
Prescriptions:

Not covered
Preventive Care:
  • Mammography, prostate and colorectal cancer screenings only
  • Deductible and coinsurance
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: Covered as any other condition
Maternity:

Not covered
Mental Health:
  • Inpatient: 8 days per calendar year
  • Outpatient: 12 visits per calendar year
Other considerations
Network(s):

Preferred Providers

  • Preferred Network (most medical services)

Participating Providers

  • Providers outside of the preferred network

Benefit Summary

Rates

 

Optional Benefits

Complete your health care plan with Dental coverage:

DentalOne


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

Learn more about DentalOne »

Medical Exclusions and Limitations

PDF (32k) Exclusions & Limitations: All Individual Plans

Acupuncture 12 visits per calendar year
Alcoholism Not covered
Ambulance $2,000 per calendar year, ground only
Cosmetic Surgery Not covered
Custodial Care and Rest Cures Not covered
Drug Abuse/Addiction treatment Not covered
Growth Hormone Therapy $25,000 per calendar year
Hearing Aids Not covered
Home Health Care 130 visits per calendar year
Home Medical Equipment

$2,500 per calendar year
Hospice 6 months maximum
Marital and family counseling Not covered; family counseling covered as specified in the Mental Disorders benefit
Mental Health Treatment Inpatient: 8 days per calendar year
Outpatient: 12 visits per calendar year
Occupational Injury Not covered
Rehabilitative Care (inpatient) $4,000 per calendar year
Rehabilitative Care (outpatient) $2,000 per calendar year
Skilled Nursing Facility Care 30 days per calendar year
Smoking Cessation $500 lifetime maximum
Spinal Manipulation 10 manipulations per calendar year
Sterilization Not covered
Temporomandibular Joint Disorder Not covered
Waiting Periods
Pre-existing conditions 9-month waiting period
Transplants
  • $250,000 lifetime maximum
  • 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 a contract for a complete list and more in-depth explanation of benefits and the limitations and exclusions that apply.

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