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Regence BreakthruSM 50 - $5,000 Deductible

Washington Health Plans | Regence Breakthru 50 - $5,000 Deductible

    • Lowest rates of our Breakthru plans, for the budget minded.
    • Back to basics means you don't have to pay for what you don't need, like maternity, preventive care, prescriptions and vision.
    • Catastrophic coverage protects you for serious injuries and illnesses.

Coverage at a Glance


Deductible:
Annual OOP Max: Not applicable on this plan
Lifetime Max: $2 million per member
Copay: Not applicable on this plan
Coinsurance: 50% preferred providers, 50% participating
Coinsurance Max: $10,000 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:
  • $5,000 per member
  • Family maximum of three individual deductibles
Annual OOP Max: Not applicable on this plan
Coinsurance Max:
  • You pay $0 after reaching $10,000 coinsurance maximum per member using preferred providers
  • Family coinsurance maximum of three individual deductibles using preferred proiders
  • No maximum when using participating providers
Lifetime Max: $2 million paid by Regence per member
Copay: Not applicable on this plan
Coinsurance:
  • You pay 50% when using preferred providers
  • You pay 50% when using participating providers
Everyday Needs
Prescriptions:
  • RegenceRx discount program
  • Mail order not available
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
  • Acupuncture limited to 12 visits per calendar year maximum
  • Spinal manipulations limited to 10 manipulations per calendar year maximum
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

Individual rates typically are adjusted each August 1. However, due to two transplant mandates recently passed through legislation, these rates will be adjusted slightly effective January 1, 2010, the effective date of the new mandates. Questions? Please call our Individual Marketing Specialists at 1 (888) 734-3623.

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 and 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 Provided for subscriber only
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 Not covered
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
  • $350,000 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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