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     HSA Overview     Qualified Expenses   LifeWise HSA Plan     Benefits/Coverage     Rates     Apply Now!     Provider Directory   Regence 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) WiseSavings 20 (HSA Qualified) Summary of Benefits All services subject to plan's deductible, unless otherwise noted. PCY = Per Calendar Year Deductible, coinsurance and copay represent WHAT YOU PAY.   Individual Plan Family Plan MEDICAL PLAN Preferred Provider Non-Preferred Provider Preferred Provider Non-Preferred Provider Annual Deductible PCY (Choose one) Option A: $1,750  Option B: $3,000 Per Individual Option A: $3,500  Option B: $6,000 Family** Coinsurance (what you pay) 20% 40% 20% 40% Annual Coinsurance Maximum Option A: $2,500 Option B: $1,750 Unlimited Option A: $5,000 Option B: $3,500 Unlimited Out-of-Pocket Maximum (deductible + coinsurance maximum) Option A: $4,250 Option B: $4,750 Unlimited Option A: $8,500 Option B: $9,500 Unlimited COVERED SERVICES Lifetime maximum $2 million   Office Visits including Urgent Care & Naturopathy Deductible, then 20% Deductible, then 40% Deductible, then 20% Deductible, then 40% Preventive Care Exams ($300 PCY) Routine medical exam, sports physical & women's health/well baby exams Covered in Full (up to $300 PCY) Not Covered Covered in Full (up to $300 PCY) Not Covered Preventative Screenings PAP smear, PSA testing, colorectal colon cancer screening, cholesterol screening & bone density test Deductible, then 20% Deductible, then 40% Deductible, then 20% Deductible, then 40% Immunizations Covered in Full Not Covered Covered in Full Not Covered Pharmacy - Retail (30-day supply) Not Covered Pharmacy discount program* available Not Covered Pharmacy discount program* available Pharmacy - Mail Service (90-day supply) Outpatient Diagnostic Imaging & Lab Services Deductible then 20% Deductible then 40% Deductible then 20% Deductible then 40% Mammography DEDUCTIBLE WAIVED then 20% DEDUCTIBLE WAIVED then 20% Emergency Room Care Deductible then 20% Deductible then 20% Deductible then 20% Deductible then 20% Ambulance Transportation Air: unlimited; Ground: $5,000 PCY limit Outpatient & Inpatient Facility Care Deductible then 20% Deductible then 40% Deductible then 20% Deductible then 40% Rehabilitation (Outpatient: 15 visits PCY;   Inpatient: 10 days PCY) Physical, Occupational, Massage and Speech Therapy; Cardiac & Pulmonary Rehabilitation Durable Medical Equipment & Prosthetics ($5,000 PCY) Spinal & Other Manipulations (12 visits PCY) Deductible then 20% Deductible then 40% Deductible then 20% Deductible then 40% Acupuncture (12 visits PCY) Home Health Care (120 visits PCY) Deductible then 20% Deductible then 40% Deductible then 20% Deductible then 40% Skilled Nursing Facility (20 days PCY) Includes room & board, ancillaries & professional fees Hospice Care (Inpatient: 10 days PCY; Respite: 240 hours PCY) Maternity Care Not Covered Not Covered Mental Health - Outpatient Office Visit (6 visits PCY) Deductible then 20% Deductible then 40% Deductible then 20% Deductible then 40% Mental Health - Inpatient Facility Care (6 visits PCY) Vision Care - Routine Exam (One exam per two calendar years) Not Covered Not Covered Vision Care - Hardware (Per two calendar years) Transplants (12-month waiting period; $250,000 lifetime benefit) Organ & Bone Marrow Deductible then 20% Not Covered Deductible then 20% 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. ** Family = Individual + one or more family members. Services for all family members covered under the same HSA-qualified plan are applied to the family deductible. The family deductible must be met before services are covered for any enrolled family members. Deductible, coinsurance and copay represent what you pay. Benefits apply after calendar year deductible is met, unless otherwise noted as “Deductible Waived,” “Copay” or “Covered in Full.” This is 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.