Your Regence HSA (Health Savings Account) Healthplan provides coverage for services provided by In-Network and Out-Of-Network
physicians and other professional providers as listed below. Once enrolled, the Participating Network is the panel of providers for
which you will receive the greatest benefits.
|
HSA Healthplan |
| Deductibles |
Single - $2,500, $3,500
Family - $5,000, $7,000 |
| Lifetime benefit maximum |
$2 million per individual |
| Benefit Features |
In-Network Benefit |
Out-Of-Network Benefit |
| Out-of-pocket maximum amount
per calendar year including deductible |
Single - $5,000
Family - $10,000 |
None |
| After your maximum coinsurance
is met each calendar year, we pay |
100% |
N/A |
Preventive Care Services
|
Deductible Waived - We Pay |
| Immunizations for adults and children |
80% |
60% |
Well-baby exam and well child care
Including related lab & x-ray services |
80% |
60% |
| Annual women's exams including Pap tests & mammograms |
80% |
60% |
| Adult routine physical exams including related lab & x-ray services |
80% |
60% |
| Professional Services |
After Deductible We Pay |
| Office visits and other office procedures |
80% |
60% |
| Therapeutic injections and allergy shots |
80% |
60% |
| Surgery |
80% |
60% |
| Diagnostic radiology and lab |
80% |
60% |
| Hospital Services
|
After Deductible We Pay |
| Emergency room care for medical emergency |
80% |
| Emergency room card for non-emergency |
80% |
60% |
Inpatient stay
Including surgery, rehabilitation and mental illness |
80% |
60% |
Outpatient services
Including surgery, diagnostic radiology, and
lab |
80% |
60% |
| Other Services |
After Deductible We Pay |
| Ambulance |
80% |
Outpatient Rehabilitation
Physical, speech, and occupational therapy |
80% |
60% |
| Skilled nursing facility, home health, and hospice care |
80% |
60% |
| Durable medical equipment and supplies |
80% |
60% |
| Neurodevelopmental therapy |
80% |
60% |
| Prescription Benefits |
After Deductible We Pay |
| Pharmacy purchased prescription medications (30-day supply) |
50% |
|
Additional Benefits |
| BlueCard ® program |
Provides savings
nationwide. To receive the best benefit, please use BlueCard
PPO providers of the Blue Cross and/or Blue Shield Plan in the area where
you receive the service. Using providers outside of the Blue Cross and/or Blue Shield Plan may likely result in
greater out of pocket expenses. Find a provider near you at www.bcbs.com. |
| Please note: Single coverage deductible and out-of-pocket maximum applies when an individual is enrolled without dependents.
Family coverage deductible and out-of-pocket maximum applies when an individual and one or more dependents are enrolled.
Prior to benefits being paid, the entire family deductible must be met. |
Asuris NW Health 
