of this page and prevents the definitions of the various terms underlined below
from appearing when you place your mouse cursor over them.
coverage for immediate access to care.
wellness programs encourage and reward members for reaching
their health goals.
- Encourages employee involvement as your client's employees
determine how to access care based on their own personal health goals and
Pharmacy benefits are a standard part of the Innova plan design with four options to choose from.
Generic (not subject to deductible)
*Copays and coinsurance apply
to the out-of-pocket maximum.
If an equivalent generic medication is available and a brand-name medication is chosen, the member is responsible for paying the applicable brand-name copay/coinsurance plus the difference in price between the equivalent generic medication and the brand-name medication not to exceed total retail cost.
Brand Deductible** (optional)
$250 deductible (brand
$500 deductible (brand
**Brand deductible does not accrue to the member's out-of-pocket maximum.
Our health-focused plans come with comprehensive wellness resources. These programs are not insurance, but they are offered in addition to your medical plan to help your employees get information and support when they need it.
Integrated Care Management
Integrated Care Management provides specialized, targeted attention and support for employees who need assistance in managing their care. A Personal Care Team of clinical experts is ready to assist employees and their families with an ongoing medical condition, or serious illness or injury. The program provides easy access to one-on-one support focused on closing care gaps. Learn more about the program.
24-hour nurse line
A 24-hour nurse hotline staffed by registered nurses. The nurse hotline is a great way for members to get medical questions answered without having to make an appointment with a doctor or visit an urgent care clinic. By explaining symptoms or concerns, members can get advice on what they can do on their own --or get a nurse's opinion on whether they should see a doctor right away.
Members-only discount program offers your employees savings from a number of nationally recognized, health-related companis. Learn more about Regence Advantages.
Your client can round out the benefits their employees will enjoy by adding
optional plan benefits.
Chemical Dependency/Mental Health (Combined Benefit)
- Groups of 2-50: Chemical Dependency Treatment/Mental Health combined. 50% coinsurance. 8 inpatient days/ 12 outpatient visits per calendar year. Subject to deductible. Not subject to coinsurance maximum. Category 3 may be subject to balance billing.
- Groups of 2+: Chemical Dependency Treatment/Mental Health combined. Regular plan coinsurance levels. No benefit maximums. Subject to deductible and coinsurance maximum. Category 3 may be subject to balance billing.
Unlimited Spinal Manipulations
- no benefit maximum
- Category 1 & 2, Category 3 may be subject to balance billing
Vision (exempt from medical deductible)
- 100% coverage for annual eye exam (Category 1 & 2, Category 3 may be
subject to balance billing)
- not subject to deductible
- up to $150 in hardware annually
Three plans that offer something for everyone. Available as stand-alone,
or paired with ActivateSM, Innova or EngageSM.
Employer Assistance Program (EAP)
- 24-hour crisis assistance
- up to 4 face-to-face counseling sessions per incident
- legal and financial services
- read more
and Limitations to Coverage
These exclusions apply to the medical plans only and do not apply to the wellness programs.
Preventive services and immunizations are covered according to guidelines set forth by the United States Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA).
No benefits are provided for treatment relating to a transplant until the member has been covered under this or a prior plan for twelve consecutive months. There is a nine-month waiting period that must be met prior to benefits being available for pre-existing conditions. Members may receive credit from prior medical coverage. Pre-existing condition waiting periods do not apply to Members up to age 19.
Outside the Service Area
Members have the security of knowing they can access Blue Cross and/or Blue Shield (Blue Plan) providers across the country and worldwide through the BlueCard® Program. Plan benefits apply as described above, and members may receive discounts on their services.
General Medical Exclusions
Coverage is not provided for any of the following, including direct complications or consequences that arise from:
- Cosmetic/Reconstructive Services and Supplies except for reconstruction for functional injury and disease, to treat a congenital anomaly for members up to age 18, and for breast reconstruction following a medically necessary mastectomy to the extent required by law
- Counseling in the absence of illness
- Custodial Care: Non-skilled care and helping with activities of daily living
- Dental Examinations and Treatments
- Fees, Taxes, Interest: Charges for shipping and handling, postage, interest, or finance charges that a provider might bill
- Government Programs: Benefits that are covered, or would be covered in the absence of this plan, by any federal, state or governmental program
- Infertility except to the extent covered services are required to diagnose such condition
- Investigational Services: Treatment or procedures (health interventions) and services, supplies, and accommodations provided in connection with investigational treatments or procedures
- Medications without a Prescription Order
- Military Service Conditions: The treatment of any condition caused by or arising out of a member's active participation in a war or insurrection or conditions incurred in or aggravated during performance in the Uniformed Services
- Motor Vehicle Coverage and Other Insurance Liability
- Non-Direct Patient Care including appointments scheduled and not kept, charges for preparing medical reports, itemized bills or claim forms, and visits or consultations that are not in person, including telephone consultations and email exchanges
- Obesity or Weight Reduction/Control: Medical treatment, medication, surgical treatment (including reversals), programs, or supplies that are intended to result in or relate to weight reduction, regardless of diagnosis
- Orthognathic Surgery except for congenital conditions, temporomandibular joint disorder, injury, and sleep apnea
- Personal Comfort Items: Items that are primarily for comfort, convenience, cosmetics, environmental control, or education
- Physical Exercise Programs and Equipment including hot tubs or membership fees at spas, health clubs, or other such facilities; applies even if the program, equipment, or membership is recommended by the member’s provider
- Private Duty Nursing including ongoing shift care in the home
- Riot, Rebellion and Illegal Acts: Services and supplies for treatment of an illness, injury or condition caused by a member’s voluntary participation in a riot, armed invasion, or aggression, insurrection, or rebellion or sustained by a member while committing an illegal act or felony
- Routine Foot Care including treatment of corns and calluses and trimming of nails
- Routine Hearing Care: Routine hearing examinations, programs, or treatment for hearing loss including hearing aids (externally worn or surgically implanted) and the surgery and services necessary to implant them, except for cochlear implants
- Self-Help, Self-Care, Training, or Instructional Programs including childbirth classes, diet and weight monitoring services and instruction programs, including those to learn how to stop smoking and programs that teach a person how to use durable medical equipment or how to care for a family member
- Services and Supplies Provided by a Member of Your Family
- Services and Supplies That Are Not Medically Necessary
- Services to Alter Refractive Character of the Eye
- Sexual Dysfunction: Regardless of cause, except for counseling provided by covered, licensed mental health practitioners, if chemical dependency/mental health benefit coverage is selected
- Sexual Reassignment Treatment and Surgery: Treatment, surgery, and counseling services for sexual reassignment
- Third-Party Liability: Services and supplies for treatment of illness or injury for which a third party is or may be responsible
- Travel and Transportation Expenses other than covered ambulance services
- Work-Related Conditions except for subscribers who are owners, partners, or corporate officers and are exempt from state or federal workers' compensation law
This is a brief summary of benefits; it is not a certificate of coverage. All benefits must be medically necessary. For full coverage provisions, refer to the contract.
Available to all
fully insured groups.
Innova & Engage
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Consumer Directed Health Programs
Combine your Regence medical product with one of our CDH programs to maximize savings potential and encourage smart consumerism. Learn more.
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