Regence BlueShield   LifeWise of WA Plans   Comprehensive Plans     WiseChoices Prime   Catastrophic Plans     WiseEssentials Rx     WiseEssentials CoPay     WiseSimplicity   HSA Plan     WiseSavings   Plan Rates   Apply Now!   Prescription Drugs   Provider Directory   Waiting Period     & Exclusions   FAQ's   Group Health   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) WiseSimplicity 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 (no family deductible) $10,000 $20,000 Coinsurance (what you pay) 0% 50% Annual Coinsurance Maximum $0 Unlimited COVERED SERVICES Lifetime maximum $2 million   Office Visits including Urgent Care & Naturopathy Deductible, then covered in full Deductible, then 50% Preventive Care Exams Routine medical exam, sports physical & women's health/well baby exams Covered in full* (only 1 exam PCY) Preventative Screenings PAP smear, PSA testing, colorectal colon cancer screening, cholesterol screening & bone density test Deductible, then covered in full Immunizations Deductible, then covered in full Not Covered Pharmacy - Retail Not Covered (Pharmacy discount program available**) Not Covered (Pharmacy discount program available**) Pharmacy - Mail Service Outpatient Diagnostic Imaging & Lab Services Deductible, then covered in full Deductible, then 50% Mammography Covered in full* Emergency Room Care Copay waived if direct admit to an inpatient facility $100 copay, then subject to deductible, then covered in full $100 copay, then subject to deductible, then covered in full*** Ambulance Transportation Air: unlimited; Ground: $5,000 PCY limit Deductible, then covered in full Deductible, then covered in full*** Outpatient & Inpatient Facility Care Deductible, then covered in full Deductible, then 50% Rehabilitation (Outpatient: 20 visits PCY; Inpatient: 8 days PCY) Physical, Occupational, Massage & Speech Therapy; Cardiac & Pulmonary Rehabilitation Durable Medical Equipment & Prosthetics Not Covered Not Covered Spinal & Other Manipulations (12 visits PCY) Deductible, then covered in full Deductible, then 50% Acupuncture (12 visits PCY) Home Health Care (130 visits PCY) Deductible, then covered in full 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 Not Covered Not Covered Vision Care - Hardware Mental Health - Outpatient Office Visit (6 visits PCY) Deductible, then covered in full Deductible, then 50% Mental Health - Inpatient Facility Care (6 days PCY) Deductible, then covered in full Transplants (12-month waiting period; $350,000 lifetime benefit) Organ & Bone Marrow Deductible, then covered in full Not Covered    * Benefits provided at 100% of allowable charges; not subject to deductible      or coinsurance.   ** 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 deductible 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© 1998-2009, Maddock & Associates  |  Privacy Statement Problems viewing this page? Contact the webmaster.