What comes out of my pay?How much will I pay out of my own pocket?What is Snowbird contributing?What will I pay after I meet my deductible?Will my doctor be in-network?
Network Options: BluePoint Valuecare Network or BluePoint Standard Network
You’ve built a trusting relationship and you want to keep it. But, did you know that you can also save money by using an in-network provider? That’s why you will be able to choose a provider network that is right for you and your family’s health and wellbeing.
(888) 367-2119 | regence.com | Group #10000535
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Medical Plans |
Traditional $900 Copay Plan
With this Traditional $900 PPO Plan you will only have access to the BluePoint ValueCare Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with Regence to see if your provider is in the BluePoint ValueCare Network so that you can take advantage of greater discounts on care for you and your family.
With this Traditional $900 PPO Plan you will only have access to the BluePoint ValueCare Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with Regence to see if your provider is in the BluePoint ValueCare Network so that you can take advantage of greater discounts on care for you and your family.
TRADITIONAL $900 COPAY PLAN
BLUEPOINT VALUECARE NETWORK
BLUEPOINT VALUECARE NETWORK
In-Network
Out-of-Network*
Annual Deductible
Embedded
Jan 1 - Dec 31
Embedded
Jan 1 - Dec 31
You pay up to
$900 per individual
$900 per member / $2,700 per family
$900 per individual
$900 per member / $2,700 per family
You pay up to
$2,250 per individual
$2,250 per member / $6,750 per family
$2,250 per individual
$2,250 per member / $6,750 per family
Coinsurance
You pay 20% AD
You pay 40% AD
Out-of-pocket Maximum
Embedded
Jan 1 - Dec 31
Embedded
Jan 1 - Dec 31
No more than
$7,000 per individual
$7,000 per member / $14,000 per family
$7,000 per individual
$7,000 per member / $14,000 per family
No more than
$15,000 per individual
$15,000 per member / $30,600 per family
$15,000 per individual
$15,000 per member / $30,600 per family
Preventive Services
You pay
$0 according to government guidelines
$0 according to government guidelines
You pay
40% AD
40% AD
Office Visits
Primary Care
Specialist
Chiropractor
Doctors on Demand Telemedicine
Primary Care
Specialist
Chiropractor
Doctors on Demand Telemedicine
You pay
$40 copay
$50 copay
20% AD
$20 copay
$40 copay
$50 copay
20% AD
$20 copay
You pay
40% AD
40% AD
40% AD
Not Covered
40% AD
40% AD
40% AD
Not Covered
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
$40 copay
20% AD
$40 copay
20% AD
You pay
40% AD
40% AD
40% AD
40% AD
Emergency Services
Urgent Care
Emergency Room
Urgent Care
Emergency Room
You pay
$60 copay
$250 copay, then 20%
$60 copay
$250 copay, then 20%
You pay
40% AD
Covered as In-Network
40% AD
Covered as In-Network
Inpatient & Outpatient
Inpatient Hospital
Outpatient Surgery
Inpatient Hospital
Outpatient Surgery
You pay
20% AD
20% AD
20% AD
20% AD
You pay
40% AD
40% AD
40% AD
40% AD
Prescription Medication
Tier 1 / Tier 2 / Tier 3 / Tier 4 / Tier 5 / Tier 6
Retail (30-day supply)
You pay $15 / 25% AD / $35 / $75 / $175 / 50% AD
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
High Deductible Health Plan $1,200 (HDHP)
With this Regence High Deductible Health Plan $1,200 you you will have access to the BluePoint Standard Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with Regence to see if your provider is in the BluePoint Standard Network so that you can take advantage of greater discounts on care for you and your family.
With this Regence High Deductible Health Plan $1,200 you you will have access to the BluePoint Standard Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with Regence to see if your provider is in the BluePoint Standard Network so that you can take advantage of greater discounts on care for you and your family.
HIGH DEDUCTIBLE HEALTH PLAN $1,200
BLUEPOINT STANDARD
BLUEPOINT STANDARD
In-Network
Out-of-Network*
Annual Deductible
Embedded
Jan 1 - Dec 31
Embedded
Jan 1 - Dec 31
You pay up to
$1,200 per individual
$1,200 per member / $3,600 per family
$1,200 per individual
$1,200 per member / $3,600 per family
You pay up to
$1,800 per individual
$1,800 per member / $5,400 per family
$1,800 per individual
$1,800 per member / $5,400 per family
Coinsurance
You pay 20% AD
You pay 30% AD
Out-of-pocket Maximum
Embedded
Jan 1 - Dec 31
Embedded
Jan 1 - Dec 31
No more than
$7,150 per individual
$7,150 per member / $14,300 per family
$7,150 per individual
$7,150 per member / $14,300 per family
No more than
$7,500 per individual
$7,500 per member / $15,000 per family
$7,500 per individual
$7,500 per member / $15,000 per family
Preventive Services
You pay
$0 according to government guidelines
$0 according to government guidelines
You pay
30% AD
30% AD
Office Visits
Primary Care
Specialist
Chiropractic
Doctor On Demand Telemedicine
Primary Care
Specialist
Chiropractic
Doctor On Demand Telemedicine
You pay
20% copay
20% copay
20% copay
20% copay
20% copay
20% copay
20% copay
20% copay
You pay
30% AD
30% AD
30% AD
Not Covered
30% AD
30% AD
30% AD
Not Covered
Mental Health Services
Office Visit
Inpatient
Office Visit
Inpatient
You pay
20% AD
20% AD
20% AD
20% AD
You pay
30% AD
30% AD
30% AD
30% AD
Emergency Services
Urgent Care
Emergency Room
Urgent Care
Emergency Room
You pay
20% AD
20% AD
20% AD
20% AD
You pay
30% AD
Covered as In-Network
30% AD
Covered as In-Network
Inpatient & Outpatient
Inpatient Hospital
Outpatient Surgery
Inpatient Hospital
Outpatient Surgery
You pay
20% AD
20% AD
20% AD
20% AD
You pay
30% AD
30% AD
30% AD
30% AD
Prescription Medication
Tier 1 / Tier 2 / Tier 3 / Tier 4
Retail (30-day supply)
You pay 20% AD / 20% AD / 20% AD / 20% AD
AD: After Deductible
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
* Providers may charge more than the plan allows when you receive services out-ofnetwork. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2023 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
