Your Medical Plan provides benefits to help you and your family maintain your good health AND provide coverage for medical and behavioral health expenses when they do arise.
The Medical Plan is administered by Regence BlueCross BlueShield of Oregon. You have the flexibility to choose any provider (doctor, hospital, or service). However, you’ll pay less if you use a Regence in-network provider.
If you are a Medicare-eligible Retiree who is enrolled in the Trust’s fully-insured Plan through Regence, please click here to learn more about your Plan benefits.
To find a Regence in-network provider, go to Regence.com, sign in and click “Find a Doctor.”
TIP: An in-network provider may refer you to an out-of-network provider for services (such as lab work, tests and imaging). Ask if the provider is in-network before you get any services.
This example assumes the annual deductible has been met.
Choose the right kind of care for your health care needs:
Your benefits give you options for confidential, professional behavioral health care.
Every year, starting on January 1, you must pay for all covered services until your payments add up to the annual deductible amount. These payments include your share of costs up to the Plan’s allowed amount, but do not include any balance-billed charges, your monthly contribution, or services the Plan doesn’t cover. You do not have to meet your deductible for the Plan to pay for certain covered services. Please refer to the Active Employee Plan SPD for information regarding which covered services are not subject to the deductible and for information regarding the deductible carryover.
When you have paid the annual deductible, the Plan starts to pay benefits at the applicable coinsurance percentage for the services you receive.
Here’s how the family deductible works for Active Employees (there is no Family Deductible for Non-Medicare Retirees):
See your annual deductible balance at regence.com; sign in to your account, click My Plan, then Check benefits and coverage.
After you have paid the annual deductible amount, the Plan pays a share, and you pay a share, for the covered services you receive. The Plan pays 100% for certain covered services. The percentage the Plan pays is based on the provider you choose (see examples above) and the service you receive.
The Plan’s payment is based on the amount that is allowed by the Plan (not what the provider charges).
The out-of-pocket maximum is the most you will have to pay in a year for covered services. Once you pay this amount, the Plan pays 100% for all covered services for the rest of the calendar year.
Here’s how the Family Out-of-Pocket Maximum works for Active Employees (there is no Family Out-of-Pocket Maximum for Non-Medicare Retirees):
What you pay for coinsurance or copayments is applied to your out-of-pocket maximum, but what you pay towards any charges above the Plan’s allowed amount from out-of-network providers, your monthly contribution for coverage, or non-covered services are not applied to your out-of-pocket maximum.
See your annual out-of-pocket balance at regence.com; sign in, click My Plan, then Check benefits & coverage.
(*Payment is based on the Plan’s allowed amount; the Provider may charge more.)
Your Medical Plan gives you access to these programs at no cost to you:
Livongo Diabetes Care: Participants use a glucose meter that sends data to Livongo, and based on their results, receive support from expert coaches to improve health outcomes (all at no cost to you). Plus, free test strips are automatically delivered to your home. Click here for details (registration code: BLEDSOE).
NEW! Hinge Health Digital Physical Therapy: Through Hinge Health, participants 18 years and older can conquer non-work related joint and muscle pain with digital exercise therapy specifically tailored to their needs—all from the comfort of home. You’ll receive real-time feedback in the Hinge Health app while performing the exercises. And a personal coach and a physical therapist will connect with you to help keep you on track. Best of all, there’s NO cost to you! Click here to get started or call (855) 902-2777.
Tobacco Cessation Program: Free & Clear® Quit for Life® program offers one-on-one coaching and free nicotine replacement therapy. It is available to participants 18 years and older. Click here for details.
Regence Empower: This program can help you start a fitness routine, lose weight, improve your sleep, and reach other healthy goals. Click here for details.
Regence Condition Manager: For participants with a chronic conditions (such as diabetes, heart disease, asthma and/or depression), this program provides one-on-one assistance from health care professionals who provide extra support in addition to your doctor’s treatment plan. Click here for details.
Regence Care Management: For cases of serious illness or injury with the potential for major continuing expense, this program helps patients obtain the best benefit coverage. Click here for details.
Regence BlueCard Worldwide® Program: If you need medical assistance services outside of the United States (including locating a doctor or hospital), contact the Regence BlueCard Worldwide Service Center at (800) 810-BLUE (toll free) or collect at (804) 673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange care for covered medical services. While there is no cost to use this, when you receive care from providers outside of the United States, you will typically have to pay the providers and submit claims for reimbursement of any covered services received.