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Regence BreakthruSM 70 - $1,000 Deductible

Washington Health Plans | Regence Breakthru 70 - $1,000 Deductible

    • Coverage begins on day one. You can visit the doctor for a simple copay before using your deductible.
    • Preventive care for everyone is standard, not something you pay extra for.
    • Vision care: you pay $30 for an annual exam and receive up to $200 for glasses and/or contacts.

Coverage at a Glance


Deductible:
Annual OOP Max: Not applicable on this plan
Lifetime Max: $2 million per member
Copay: $30 preferred, $40 participating
Coinsurance: 30% preferred providers, 50% participating
Coinsurance Max: $5,000 per member
Network(s): Preferred Providers

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

Basic Features

Cost Sharing
Deductibles:
  • $1,000 per member
  • Family maximum of three individual deductibles
Annual OOP Max: Not applicable on this plan
Coinsurance Max:
  • You pay $0 after reaching $5,000 coinsurance maximum per member using preferred providers
  • Family coinsurance maximum of three individual deductibles using preferred providers
  • No maximum when using participating providers
Lifetime Max: $2 million paid by Regence per member
Copay:
  • You pay $30 when using preferred providers
  • You pay $40 when using participating providers
Coinsurance:
  • You pay 30% when using preferred providers
  • You pay 50% when using participating providers
Everyday Needs
Prescriptions:
  • $10 copay for generic medications purchased at the pharmacy
  • $20 copay for generic mail order
  • You pay 30% when using the formulary
  • You pay 50% when not using the formulary
  • $3,000 annual limit on all medications
  • No deductible
  • RegenceRx discount program after limit is reached
Preventive Care:
  • You pay coinsurance only
  • No deductible
  • All preventive care services, including related lab tests, screening procedures and x-rays are limited to $200 per calendar year (routine colorectal cancer screenings not subject to maximum)
Vision:
  • One routine eye exam per calendar year
  • You pay $30 copay using preferred providers
  • You pay $40 copay using participating providers
  • You pay $0 up to $200 per calendar year maximum on vision hardware
Office Visits:
  • You pay $30 copay using preferred providers
  • You pay $40 copay using participating providers
  • No deductible
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: Deductible and coinsurance
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)

Benefit Summary

Note: there are separate summaries here for medical and prescription benefits.

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 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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