Plan factors |
Traditional Medical Plan (TMP) |
Select Network |
Monthly Premium |
$0 after July 1 |
$ 46 individual
$92 Individual plus spouse or child(ren)
$138 Individual plus spouse and child(ren) |
Deductible |
Individual: Greater of $200, or 0.2% of pay
Family: Greater of $600, or 0.6% of pay |
None |
Non-Network Coinsurance |
60% after deductible |
No benefits paid |
Office visits –
Co-payment |
$15 (does not apply towards deductible or out of pocket maximum) |
$10 (does not apply towards deductible or out of pocket maximum) |
Out-of-Area Coverage |
In general: Better than Select Network, with 60% coverage for non-network.
For children residing outside the service area: Nationwide service area, therefore, network and non-network percentages apply. Use any BlueCross Blueshield PPO provider to receive in-network benefits. |
In general: For emergency care only because of no coverage for non-network providers.
For children outside the service area: All covered services received outside the service area by eligible dependent children living outside the service area, including preventive care, will be provided at 80% of the allowed amount after the annual $400 deductible, subject to the benefit provisions and limitations of the plan. |
Prescription Drugs – Retail (participating pharmacy)
(up to a 34-day supply) |
Service Provider: Medco
Generics: covered 90%
Brand formulary: Covered 80%
Brand nonformulary: Covered 70%
Members pay 100% of the discounted cost at the pharmacy and are sent a check from Regence based on the applicable benefit percentage.
Retail drugs on the TMP are subject to the deductible. |
Service Provider: RegenceRx
Generics: $5
Brand formulary: $15
Brand nonformulary: $30
Prescriptions obtained out of network are not covered. |
Prescription Drugs – Mail (up to a 90-day supply) |
Generics: $10
Brand formulary: $30
Brand nonformulary: $60 |
Generics: $10
Brand formulary: $30
Brand nonformulary: $60 |
Preventive Care |
100% - no co-pay, $200 maximum per adult exam. One exam/three benefit years if under age 35. One exam/benefit year if age 35 and older.
For children: Eight exams from birth to 24 months, one routine exam per year for ages 2-5. No preventive benefits for age 6 and older. |
100% |
Annual Out-of-Pocket Maximum |
$2,000 per individual
$4,000 family |
Not Applicable |
Spinal and extremity
manipulations |
$15 copay – limited to 26 visits |
$10 copay – limited to 26 visits |
Access to “Alternative” Medicine Providers |
Medical Doctors performing naturopathic services are covered. Naturopath and massage therapy providers are not covered.
Acupuncture: Covered when medically necessary for a covered illness and performed by a L.A.C., M.D. or D.O. |
$10 co-pay for naturopaths, massage therapists, acupuncturists, etc, in the SelectNetwork. |
Mental Health/Substance Abuse |
Service Provider: Value Options
No changes |
Service Provider: Value Options
No changes |
Vision |
Service Provider: Vision Service Plan (VSP)
$15 copayment/annual exam
Schedule of benefits for hardware (Same as Select Network, but TMP members also have access to additional VSP discounts) |
Service Provider: Regence
$10 copayment/annual exam
Schedule of benefits for hardware (same as TMP) |
Lifetime Maximum Benefit |
$1,500,000 per individual |
$1,500,000 per individual |
Provider Network |
Regence BlueShield PPO network –
see website for detailed listing of providers |
Regence Selections network –
see website for detailed listing of providers |
Hospital Network |
Currently, the same hospitals participate in both networks – see website for detailed listing |
Currently, the same hospitals participate in both networks – see website for detailed listing |
