Regence BlueShield   LifeWise of WA Plans   Comprehensive Plans     WiseChoices 0 20     WiseChoices 0 30     WiseChoices 20     WiseChoices 30   Catastrophic Plans     WiseEssentials 25   HSA Plan     WiseSavings 20   Plan Rates   Apply Now!   Prescription Drugs   Provider Directory   Waiting Period     & Exclusions   FAQ's   HSA Plans   Individual Dental   Group Medical   Group Dental   Grp Life & Disability   About the Plan   Premiums   Application   US Citizens   Foreign Nationals   Long Term		(Available to Washington State Residents Only) WiseEssentials 25 Summary of Benefits All services subject to plan's deductible, unless otherwise noted. PCY = Per Calendar Year Coinsurance and copay represent WHAT YOU PAY. MEDICAL PLAN Preferred Provider Non-Preferred Provider Annual Deductible PCY (choose one)> $1,750/$2,500/$3,500 $3,500/$5,000/$7,000 Coinsurance (what you pay) 25% 50% Annual Coinsurance Maximum $5,000 Unlimited Out-of-Pocket Maximum (deductible + coinsurance maximum) $6,750/$7,500/$8,500 Unlimited COVERED SERVICES Lifetime maximum $2 million   Office Visits including Urgent Care & Naturopathy DEDUCTIBLE WAIVED on first 6 visits then 25%; additional visits subject to deductible then 25% Deductible, then 50% Preventive Care Exams Routine medical exam, sports physical & women's health/well baby exams Preventative Screenings PAP smear, PSA testing, colorectal colon cancer screening, cholesterol screening & bone density test Covered in Full Immunizations Not Covered Not Covered Pharmacy - Retail (30-day supply) Brand: $3,000 PCY limit; Generic: Unlimited Not Covered Pharmacy discount program* available Not Covered Pharmacy discount program* available Pharmacy - Mail Service (90-day supply) Brand: $3,000 PCY limit; Generic: Unlimited Outpatient Diagnostic Imaging & Lab Services DEDUCTIBLE WAIVED then 25% for $1,750 deductible plan only ------------------------------------- Deductible, then 25% for all others Deductible then 50% Mammography DEDUCTIBLE WAIVED then 25% Emergency Room Care Copay waived if direct admit to an inpatient facility $100 copay, then subject to deductible, then 25% $100 copay, then subject to deductible, then 25%** Ambulance Transportation Air: unlimited; Ground: $5,000 PCY limit Deductible, then 25% Deductible, then 25%** Outpatient & Inpatient Facility Care Deductible, then 25% Deductible, then 50% Rehabilitation (Outpatient: 20 visits PCY; Inpatient: 8 days PCY) Physical, Occupational, Massage & Speech Therapy; Cardiac & Pulmonary Rehabilitation Durable Medical Equipment & Prosthetics ($5,000 PCY) Not Covered Not Covered Spinal & Other Manipulations (12 visits PCY) DEDUCTIBLE WAIVED $25 Copay Deductible, then 50% Acupuncture (12 visits PCY) Home Health Care (130 visits PCY) Deductible, then 25% Deductible, then 50% Skilled Nursing Facility (45 days PCY) Includes room and board, ancillaries & professional fees Hospice Care (Inpatient: 10 days PCY; Respite: 240 hours PCY) Maternity Care Not Covered Not Covered Vision Care - Routine Exam (One exam per two calendar years) Not Covered Not Covered Vision Care - Hardware (Per two calendar years) Mental Health - Outpatient Office Visit (6 visits PCY) DEDUCTIBLE WAIVED then 25% Deductible, then 50% Mental Health - Inpatient Facility Care (6 visits PCY) Deductible, then 25% Transplants (12-month waiting period; $250,000 lifetime benefit) Organ & Bone Marrow Deductible, then 25% Not Covered  * In order to validate current eligibility for this discount, the pharmacy will transmit     your information to LifeWise Health Plan of Washington, including the details of     the prescription to be filled. The information may also be used for other proper     purposes. ** Unlike services received at other non-preferred providers, this service is subject     to the preferred provider deductible and coinsurance. Deductible, coinsurance and copay represent what you pay. Benefits apply after calendar year deductilbe is met, unless otherwise noted as “Deductible Waived,” “Copay” or “Covered in Full.” This is a only a summary of the major benefits provided by this plan. This is not a contract. For full coverage provisions, including a description of waiting periods, limitations, and exclusions, refer to the plan contract. E-mail us for more information and a free quote or CALL TOLL FREE 1-800-875-4490 (in the U.S.) or 1-253-854-0199 (outside the U.S.) Fax: 1-253-896-9411 Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424 Serving all of Washington at 800-875-4490, Seattle at 206-682-1628, Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291. Copyright© 1998-2008, Maddock & Associates  |  Privacy Statement Problems viewing this page? Contact the webmaster.