Individual and Family Health Benefit Plans

Transcription

1 Individual and Family Health Benefit Plans Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association Regence BlueShield 1800 Ninth Avenue Seattle, WA 98101

2

3 Thank you for your interest in a Regence Individual and family health plan. We understand that choosing the right health care plan for you and your family is an important decision. In the following pages you ll find explanations of our benefits, pricing and comparisons, as well as helpful information on how to find the right plan and our latest wellness programs. If you re curious about a health savings account, you ll find information on that too. We also provide valuable information on some of the changes brought on by the Affordable Care Act, including essential health benefits and tax credits. Our convenient online application also features tools to help you decide which plan is right for you. Just visit regence.com and follow the step-by-step directions. If you prefer to apply by mail, we ve provided all the forms you need. If you re applying for medical coverage, you ll need to complete and return the following: 1. Washington Application (required and included in this packet). 2. Affidavit of Domestic Partnership (required only for non-certified domestic partners and included in this packet). Please allow seven working days before inquiring about the status of your application. If approved, your contract s effective date will be based on the date we receive your application. We ll begin to process your application immediately, once we receive it. If we need additional information, processing could be delayed. Once coverage is offered, we ll send you your member card(s) and a contract. To learn more about everything in this booklet, visit regence.com. If you have questions about anything you see or the application process, talk to your agent or call a Regence Individual plan specialist at 1 (888)-REGENCE ( ). 1

4 Your Individual Health Care Guide at a Glance Application Rate sheets Regence Individual Direct product descriptions Regence wellness programs Health savings account description Health care reform changes Preventive health care coverage Finding a doctor Using myregence.com Pharmacy benefits Regence Advantages 2

5 Regence Individual Direct Products Gold Silver Bronze HSA 3

6 4 We re pleased to connect you and your family with the people, tools and resources that matter most to your health. No matter what your issue or question is, we re always here with answers and solutions. Regence offers a range of products, services and programs to meet your individual health needs, whether it s access to a 24-hour nurse line, intensive support with a chronic condition or something in between. Our goal is always to help you understand all your options and resources so that you can make the decision that s best for you.

7 Product Highlights Gold Silver Bronze HSA Calendar-Year Deductible Applies to all covered expenses except where noted. Calendar-Year Out-of-Pocket Maximum Applies to all covered expenses except where noted. When the out-of-pocket maximum is reached, this plan provides benefits at 100% of the allowed amount for the remainder of the calendar year. Covered Services Individual: $1,000 In-Network/ $5,000 Out-of-Network Family: $2,000 In-Network/ Out-of-Network: None Individual: $3,300 In-Network/ $12,500 Out-of-Network Family: $6,600 In-Network/ Out-of-Network: None Individual: $3,000 In-Network/ $10,000 Out-of-Network Family: $6,000 In-Network/ Out-of-Network: None Individual: $4,900 In-Network/ $12,500 Out-of-Network Family: $9,800 In-Network/ Out-of-Network: None Single: $5,000 In-Network/ $10,000 Out-of-Network Family: $10,000 In-Network/ $10,000 Out-of-Network Single: $6,250 In-Network/ $12,500 Out-of-Network Family: $12,500 In-Network/ $12,500 Out-of-Network Member responsibility for In-Network services is indicated below, after In-Network deductible is met and until out-of-pocket maximum is met, except where noted. Out-of-Network services are covered 50% after Out-of-Network deductible is met and until outof-pocket maximum is met, except where noted. Gold Silver Bronze HSA Preventive Care and Immunizations In-Network not subject to deductible. Pediatric Dental Services Various limits apply. Covered for members up to age 19. Bronze HSA: In-Network deductible applies to all dental services. All other plans: Deductible waived on all dental services. Pediatric Vision Services Covered for members up to age 19. One routine eye exam per calendar year. One pair (two lenses) and one frame per calendar year. Contacts covered in lieu of glasses. 0% 0% 0% Member responsibility for both In-Network / Out-of-Network: Preventive: 0% Basic: 20% Major: 50% Applies to In-Network out-of-pocket maximum Member responsibility for both In-Network / Out-of-Network: Eye exam: 0% Vision hardware: 0% Deductible waived on all services Applies to In-Network out-of-pocket maximum Outpatient Radiology and Lab 20% 20% 30% Chemical Dependency Treatment / Mental Health 20% 20% 30% Spinal Manipulations 10 spinal manipulations per calendar year. Skilled Nursing Facility 60 days per calendar year. Hospital Services Inpatient and outpatient services and supplies. Emergency Room Services In-Network deductible, coinsurance and In-Network out-of-pocket maximum apply regardless of provider network. 20% 20% 30% 20% 20% 30% 20% 20% 30% $200 Copay $200 Copay (waived if admitted) (waived if admitted) 30% 20% 20% Optional Additional Benefits Dental, Vision and IAP Option Covered for members 19 and older. Bronze HSA: In-Network deductible applies to all dental and vision services. Adult dental waiting periods: 6 months for Basic Services and 12 months for Major Services. Adult Dental No deductible and 0% for preventive dental care $50 deductible per calendar year for Basic and Major Care 20% for Basic Care 50% for Major Care Adult Vision No deductible One routine exam, no member responsibility Lenses and frames: $150 limit per calendar year Individual Assistance Program (IAP) Eight sessions with no member responsibility Reliant Behavioral Health Network Your Individual plan offers you your selection of any provider in our Preferred network. 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. 5

8 Perscription Highlights Gold Silver Bronze HSA Deductible (per calendar year) In-Network medical deductible applies unless otherwise specified Deductible waived for Tier 1 Deductible waived for Tier 1 Deductible applies Tier 1: Generics $10 Retail/$20 Mail $10 Retail/$20 Mail 25% Retail/20% Mail Tier 2: Brand Name (Category 1) 30% Retail/25% Mail 30% Retail/25% Mail 35% Retail/20% Mail Tier 3: Brand Name (Category 2) 50% Retail/40% Mail 50% Retail/40% Mail 50% Retail/40% Mail Tier 4: Specialty Medications 40% Retail/40% Mail 40% Retail/40% Mail 40% Retail/40% Mail Out-of-Pocket Maximum Drug List Other All out-of-pocket expenses go towards In-Network Medical Out-of-Pocket Maximum. Essential Formulary Specialty medications covered at participating retail pharmacies for first fill only. After first fill members use specialty pharmacies. Specialty Medications and Self Administrable: Up to 30-day supply per fill. Nonparticipating pharmacies not covered. More tools for more wellness Regence plans promote wellness and help you live better. All of our plans provide access to Blue Plan providers across the country and around the world through the BlueCard Program. Finally, they offer a wide range of wellness programs that are available to you at no additional cost. These programs are not insurance, but they are offered in addition to your medical plan to help you get information and support when you need it. Integrated Care Management Specialized, targeted attention and support are provided when you need help managing your care. 24-Hour Nurse Line Registered nurses are on call 24/7 to answer your health care concerns. myregence.com is an award-winning Web-based benefit information source and health community. Regence Advantages provides discounts on wellness-related goods and services. To learn more visit regence.com.

9 WHAT YOU NEED TO KNOW ABOUT HSA HEALTH PLANS An HSA Health Plan is a comprehensive health plan combined with a separate taxfree savings account that provides a simple way to pay for life s medical expenses. Comprehensive health coverage You receive preventive care benefits even before you meet your deductible. That s immediate access to commonly needed care, including: Immunizations Annual exams Well-child exams Mammograms and prostate screenings Savings and coverage go hand in hand An HSA Health Plan is really made up of two separate components that work together to create one powerful package: 1. An HSA-qualified medical plan 2. A Health Savings Account (HSA) through a financial institution The medical plan is the part that health carriers provide. To be qualified, the plan must meet specific IRS requirements, such as minimum deductibles. An HSA-qualified plan s deductible is usually higher than most other health plans deductibles. That helps keep the cost of coverage down and frees up money for the second part of the package: the health savings account. A financial institution provides the account where you save money for qualified medical expenses as defined by the IRS. Plus it s an easy way to save pre-tax dollars to pay for deductibles, coinsurance and other medical expenses that aren t covered by many medical plans. Tax-free savings account You will appreciate the control and ownership that comes with the Health Savings Account. It s not a use it or lose it account. Pre-tax dollars deposited into your account, along with tax-free interest, can roll over from year to year. Plus, you own your savings account, so you can take your money with you if you change jobs, move across the country, switch health plans or retire. Tools to help you get and stay well Every HSA Heath Plan from Regence comes with built-in wellness programs. These are not insurance but are offered in addition to your medical plan to help you get information and support when you need it. Integrated Care Management. Specialized, targeted attention and support are provided for members who need help managing their care. 24/7 nurse line. Registered nurses are on call day and night to answer health care concerns. myregence.com. An award-winning website designed to help members become well informed health care consumers. You can check claims, find patient recommended providers, compare costs and treatment options, join wellness programs, get expert support and more. Regence Advantages. A members-only discount program offers you savings from a number of nationally recognized, health-related companies. You can invest in your health with an HSA Health Plan. 7

10 Important health care reform changes for individuals The biggest changes to health care in 50 years are touching millions of people. The Affordable Care Act (ACA) changes the way we get care, alters the design and pricing of policies, guarantees benefits and requires nearly everyone to be covered. 8 New services covered Most insurance policies in or out of the health insurance marketplace must include the 10 essential health benefits defined by the federal government: Ambulatory patient services Emergency services Hospitalization Maternity/newborn services Mental health and substance abuse treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services, including chronic disease management Pediatric services, including dental and vision coverage More benefits + new rules = higher costs As new policies provide more benefits, and more people can get coverage, the cost of coverage is expected to rise. Insurance premiums will be priced to cover new requirements such as: The 10 essential health benefits listed above Additional taxes on medical industry and insurers New pricing requirements based on your age Are you eligible for help with your premium? Tax credits will be available FOR THOSE WHO QUALIFY to help pay the premium for these new, more comprehensive policies. Assistance is based on your household income and must be verified when you apply. Depending upon the level of assistance you qualify for, you may also receive help with some cost-sharing responsibilities. To learn more, go to HealthCareAndReform.com. What we re doing We ll guide you through the complexities and impacts of the new law and help you weigh your options. Our goal is to give you the information you need to make decisions that are right for you. Also, we re as concerned as you are about rising costs, and we re doing what we can to keep costs under control. We are partnering with providers and regional alliances to develop new ways to deliver care that promotes and rewards quality. We are also investing in solutions from tools that help you understand care options and costs, to personal care teams that support members with complex or chronic conditions. Learn more To learn more, visit our new, easy-to-use website: HealthCareAndReform.com. You can find the most current information and tools to guide you through decisions. You can also call us at 1 (888) If you want to learn more about health reform options and whether you qualify for a tax credit, ask your agent or visit wahealthplanfinder.org.

11 WHAT YOU NEED TO KNOW ABOUT PREVENTIVE HEALTH CARE COVERAGE Wondering what preventive care services are covered by your health plan? As you re probably aware, the federal health care reform law passed in 2010 requires insurers to include specific preventive care services in their benefit plans. Regence supports that initiative. In fact, Regence plans already provided benefits for many preventive care services, as we have long believed that preventive care and early detection are key to the long-term health and well-being of our members. This brochure explains preventive care eligibility and shows which services are available to you and the family members covered by your plan. Who s eligible for these preventive services? To be eligible for these preventive services, you must first be covered by a current Regence policy. Benefits for the federally required preventive services: Are not required in grandfathered policies, which are essentially policies that were in effect on March 23, 2010, as long as few or no benefit changes have been made to them (please note that Regence has chosen to retain grandfathered status for a very limited number of policies) May be covered by grandfathered plans that have chosen to include the benefit May apply to retiree-only plans Apply to Association plans at the Association s plan renewal date What preventive services are covered? Regence follows government guidelines to determine which preventive services we cover 1. These guidelines are updated periodically to reflect new scientific and medical advances. Additionally, current services could be revised and subject to different limitations; thus, benefits are subject to change. New guidelines will be implemented within one year of the recommendation s publication. You can learn more details about these services at healthcare.gov, including recommended child and adolescent immunization schedules. What is the coinsurance/copay for these preventive services? The services listed in this brochure will be paid at 100% (no deductibles, coinsurance or copays) when you see preferred or participating providers (Category 1 or Category 2) or in-network providers. Deductibles and/or coinsurance may apply when you see other providers. To find out if you re eligible for preventive coverage, call the Customer Service number on the back of your member card or go to the Contact Us link at regence.com. 1 Evidence-based preventive guidelines are developed and validated by the following government entities: United States Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA). Regence BlueShield 1800 Ninth Avenue Seattle, WA

12 Covered preventive services Men Women Pregnant Women Children (0-17) Health screenings, counseling and services for: Adult abdominal aortic aneurysm Alcohol misuse Suggested guidelines Screening is covered once per lifetime for men age 65 and over if they have ever smoked. Screening and behavioral counseling intervention covered for adults age 19 and older. Anemia (iron deficiency) Screening covered up to age 21, and pregnant women. Bacteriuria (urinary tract infection) Screening for asymptomatic pregnant women. Blood pressure Screening covered for adults age 18 and older. Breast cancer Screening for women age 40 and older and those at increased risk. Mammograms only. Breast cancer chemoprevention Counseling for women at increased risk. Breastfeeding equipment Manual and electric breastfeeding pumps are covered when purchased or rented from a licensed provider. Hospital-grade pumps are not covered. See Note 1. Breastfeeding - lactation support and counseling Lactation support and counseling are covered when provided by a licensed provider. Breastfeeding supplies Initial breastfeeding supplies provided with a breastfeeding pump. See Note 1. Cervical cancer Screening for sexually active women. Chlamydia infection Screening for infection. Cholesterol Screening for men age 35 and older and men ages who are at increased risk for coronary heart disease. Screening for women age 45 and older and those who are at increased risk for coronary heart disease. Colorectal cancer Screening for those age 50 and older, once every 5 years for a sigmoidoscopy and every 10 years for a colonoscopy, fecal occult blood testing annually. Congenital hypothyroidism Screening for newborns. Contraceptive education and training Education and training on contraceptive methods. See Notes 1 and 2. Contraceptive devices - implants, cervical caps, intrauterine devices (IUDs), diaphragms Generic contraceptive devices are covered. When no generic exists, a brand is covered. If a generic becomes available, the brand will no longer be covered under Preventive Care. Insertion of a device is covered under Preventive Care. Removal is covered at regular plan benefits if a Family Planning benefit applies. See Notes 1 and 2. Depression screening Screening during wellness exams. Diabetes (Type 2) Screening for adults with sustained high blood pressure. Diabetes (Gestational) Screening for pregnant women between 24 and 28 weeks of gestation and the first pre-natal visit for pregnant women at high risk for diabetes. See Note 1. Diet behavioral counseling Counseling for adults with hyperlipidemia and other risk factors. Genetic risk assessment and BRCA (breast For women with family risk of breast and ovarian cancer. cancer susceptibility) mutation counseling Gonorrhea medication Preventive medication for the eyes of newborns. Gonorrhea screening Screening for males up to age 21 and all females. Hearing One screening in the first year of life for newborns. 10

13 Covered preventive services Men Women Pregnant Women Children (0-17) Hepatitis B Screening for pregnant women. HIV Screening and counseling during wellness exams for sexually active women. Screening during wellness exams for men, women and children at increased risk. HPV Screening for women from age 30, every 3 years. See Note 1. Interpersonal and domestic violence Screening and counseling during wellness exams. See Note 1. Lead screening Screening up to age 21. Metabolic screening Screening up to age 2 months. Obesity Screening and (if obese) counseling age 6 and older. Oral health Risk assessment for preschool children. Osteoporosis Screening for women age 65 and older and all women at increased risk. Phenylketonuria (PKU) Newborn screening for genetic disorders. Prevention of falls Physical therapy for adults age 65 or older residing independently in the community who are at increased risk for falls. See Note 4. RH(D) incompatibility Screening for pregnant women. Sexually transmitted infection (STI) Counseling during wellness exams. Sickle cell Screening for children up to 12 months old. Skin cancer Counseling for children, adolescents and young adults ages 10 to 24. See Note 4. Sterilization Sterilization is covered. See Notes 1 and 2. Syphilis Screening for those at increased risk and those up to age 21; also includes pregnant women. Tobacco use Counseling and interventions. Does not include programs or classes. See also Tobacco use below. Tuberculosis Skin test for children. Vision Screening for children age 3 up to age 5. Immunization vaccines - please consult your physician for frequency Diphtheria, pertussis, tetanus (DPT) Haemophilus influenzae type b (Hib) Hepatitis A Hepatitis B Herpes zoster (shingles) Age 60 and older. Human papillomavirus (HPV) Up to age 27. Inactivated poliovirus Influenza Measles, mumps, rubella (MMR) Meningococcal Pneumococcal Rotavirus Varicella 11

14 Covered preventive services Men Women Pregnant Women Children (0-17) Prescription medications Only the types of prescription medications listed below are covered under Preventive Care. Medications require a prescription. Over-the-counter products are not covered. Get the most value for your health care dollar with preferred medications. Learn more at regencerx.com/learn/covered. Aspirin use for the prevention of For men age and women age cardiovascular disease Contraceptive injectables Generic contraceptive injectables. See Notes 1 and 2. Contraceptive pills Generic contraceptive pills. See Notes 1, 2 and 3. Contraceptive products-topical Diaphragms and patches. See Notes 1, 2 and 3. Emergency contraceptive products Generic contraceptive pills. See Notes 1, 2 and 3. Fluoride supplements For children 6 months through age 6 without sufficient fluoride Folic acid supplements For all women planning or capable of pregnancy. Iron supplements For children age 6-12 months at increased risk - drops only. Tobacco use Generic tobacco cessation medications. Vitamin D supplement For adults age 65 or older residing independently in the community who are at increased risk for falls. See Note 4. Wellness exams Suggested guidelines Well-child exams For children through 17 years of age. Annual physical exams Ages 18 and over. Notes: 1. This benefit is available upon renewal of your plan, on or after August 1, This benefit may not be available to members of groups who have applied for a religious exemption from contraceptive coverage. 3. When no generic exists in the medication category, a formulary brand is covered. 4. This benefit is available from May 1, Have questions? Call the Customer Service number on the back of your member card or go to the Contact Us link at regence.com. 12

15 Finding a doctor is quick and easy! Give our online provider directory a try. Wondering if your doctor is in our network? Or looking for a new one? Finding a doctor online takes only a few seconds using our online provider directory. Just follow these simple steps: 1. Go to regence.com. 2. Click on Find a doctor. 3. Enter your location information. 4. To find a specific caregiver, enter a provider s name. And then click Search. 5. To find a specific type of care, start keying in the specialty in the Specializing In field. A drop-down menu will appear, allowing you to click on the type of specialist you re seeking. 6. Click Search, and a list of results will appear. 7. Select your Plan Network to show doctors with the best benefit under your plan. Already a Regence member? Try our enhanced Provider Search at myregence.com. There you can see which doctors are in and out of network; see who s accepting new patients; check out a provider s philosophy of care, medical specialties, credentials and languages; and read online reviews from real patients. Prefer to call us directly? Our friendly customer service specialists can help. Just give us a call at 1 (888)

16 myregence.com Everything you ve always wanted to know about your health. In one place. Imagine a place where you can find answers and support for all of your health needs. myregence.com is your complete source of health and wellness information. And it s simple to understand. So whether you want to get started on an exercise program, need tips on eating healthier, or just want to know if we ve paid your claim, visit myregence.com today. Consider health care decisions, explore treatment options and plan ahead for financial needs. Compare cost and quality of hospitals, clinics and providers. Research treatment options and out-of-pocket cost estimates. Learn about medical conditions, medications and cost-saving generics. Explore and enjoy health articles, videos and podcasts. Discuss a variety of important health and wellness topics on My Community, a nationwide social networking site. Discover tools online or on your mobile phone that help you track your coverage and make informed decisions about your health care. Review details about your coverage. Manage your claims online and eliminate paper Explanation of Benefits. Find a doctor or specialist and read patient reviews. Healthy living has its own rewards, but Regence Rewards points can help. Earn points for browsing our health news, podcasts and videos. Receive points for healthy everyday activities such as eating fruits and veggies and walking the dog, or joining an online wellness program. Redeem points for a $25 gift card. 14

17 myregence.com Want more value for your health care dollars? Log on to myregence.com and discover online resources and interactive experiences focused on your health. It s easy to register and join. Become an informed health care consumer. Log on today. Simply use the information on your member card and follow these steps. 1. Go to myregence.com. 2. Click New Member Registration. 3. Complete the required My Member Account Information fields. The name, member and group numbers you enter must match your member card. 4. Create a user name and secure password. 5. Click Register and Login. 6. You are automatically enrolled for Rewards after you register. Want to see how it works? Watch the online Rewards video. You get Rewards points for the following: Take a confidential General Health Assessment. Learn how you ve been managing your health to date, and get practical tips on how to improve your health and well-being. Manage stress and get into shape. Reach for a healthy lifestyle with wellness programs on Weight Loss, Healthier Diet, Stress Relief, Healthy Aging, going Smoke-Free and more. What are you waiting for? Register now at myregence.com! 15

18 Find your way around your Rx plan in a flash. A quick guide to your prescription drug benefits Here s a quick reference sheet to help you better understand your prescription benefits and find the Rx information you need. It s one more tool you can use to navigate the health care system and make informed decisions about your care. Check it out! With more than 65,000 pharmacies in our network, it s easy to find one near you. Using your Rx benefits Regence members can present the Regence member card at a participating pharmacy, and the pharmacist will submit your claim online. The system will calculate the claim cost based on your pharmacy benefit, then the pharmacist will tell you how much you owe. Your member card Your Regence member card verifies that you have prescription coverage and gives our participating pharmacies everything they need in order to submit your claim online. If you have questions, just call us at the phone number on the back of your card. Your Rx Benefits Our plans provide a tiered drug benefit. When purchasing a prescription drug, the cost to you depends on the tier to which the drug is assigned. To find out if your medication is covered and what tier it is assigned to, check the formulary for this plan. Find the formulary for your health plan on regence.com. 16

19 Generics: another way to save You ll save money by using generic medications whenever possible. If the medication you need is not available in generic form, ask your doctor if another generic can be used to treat the same condition, or if there is a less expensive brand-name medication. Your doctor is the best person to determine the medication that s right for you. Prior authorization Some brand-name medications require prior authorization to ensure they re covered, such as antidepressant, diabetes, pain, heartburn and cholesterol medications. Go to regencerx.com and click on Prior Auth/Medication Quantities in the Learn About Medications section for a list of medications needing prior authorization. If you take one of these medications or keep one on hand to use as needed, then you ll need to do one of two things in order to be sure your medication will continue to be covered: 1. Try a generic first! Switch to a generic version of the brand-name medication you are taking. Just ask your pharmacist to fill your prescription with the generic rather than the brand-name. or 2. Get prior authorization for that brand-name medication. The brand-name medication might be denied if it hasn t been approved ahead of time. Ask your doctor or pharmacist to send a prior authorization request with your medical or medication history before your next refill. Your pharmacist may fax your prescription profile to 1 (888) or call 1 (800) Filing claims and getting reimbursed The pharmacist will file your claim for you, and we ll pay the pharmacy directly, so you won t have to worry about paperwork or getting reimbursed. In the rare event that you do need to file a claim, we make it painless. Just go to regencerx.com to download the proper claim form, or give us a call at the number on the back of your member card. If you misplace your member card, we ll replace it. Just call us toll-free at 1 (888) or visit myregence.com. Explore regencerx.com: a site devoted to your Rx benefits Visit regencerx.com for information specifically related to your RegenceRx prescription benefit. Use it to: Find a participating pharmacy Learn about your medication choices Preview medications to learn if they require prior authorization, or if they have any limitations or restrictions Print out a prescription claim form Go to myregence.com to make the most of all your benefits To discover all the advantages of your Regence membership beyond prescriptions, go to myregence.com. There you can view and manage details related to your medical and prescription coverage, access your formulary, explore events and rewards for healthy living, and plan ahead using our Health Cost Estimators. Maximize your benefit: Always show your member card to the participating pharmacy where you purchase your prescriptions. 17

20 Get more value for your dollar WITH TIPS AND TOOLS from RegenceRx.com. Raise your pharmacy IQ. Control your medication costs. Your online Rx tools Load up on cost-saving ideas and health care knowledge with the user-friendly tools at RegenceRx.com. There you ll find a preferred medication list, a glossary of insurance terms, prior authorization information, a pharmacy locator, specialty program information, facts about generics and much more. Here are just a few of the tools that can help you make the most of every dollar: RxPrice Guide Become more informed about your medication costs and options. After you ve checked to see whether a medication is on our preferred medication list (also known as a formulary), you can use the RxPrice Guide to browse the costs of commonly prescribed medications. You ll get detailed pricing on brand-name medications and their generic alternatives. Health Calculators These online calculators can help you see health-minded behaviors from a financial perspective. You ll learn the cost of bad habits and the benefits of good choices. For instance, calculate the actual out-of-pocket cost of smoking, or estimate how long it might take to lose weight by doing your favorite activity. ConsumerRx These educational summaries help you understand your medication options without the medical jargon. You ll find overviews of different conditions and the medications that are used to treat them, along with facts and tips to help you save money. Visit RegenceRx.com today, and take full advantage of all that RegenceRx has to offer. 18

21 Feeling good doesn t have to cost a lot. Regence Advantages As a Regence member, you can enjoy savings on the following health-related products and services. This discount program is offered to all Regence members at no additional cost (although some discounted programs offered by vendors may carry separate fees). Regence Advantages is not insurance but is offered in addition to your medical and/or dental plan(s) to help you stay healthy and live better. EyeMed Vision Care : Save 35% on a complete pair of glasses (frames and lenses). Save 15% on non-disposable contacts and $10 on contact lens fittings. These discounts are available at leading retailers and many private practice locations. QualSight : QualSight makes LASIK easy for members. You can save 40-50% off the national average price of Traditional LASIK or receive significant savings on procedures such as Custom Bladeless (all laser) LASIK. Find out if you are a potential candidate for this life-changing procedure today. TruVision : Significant discounts are offered on laser vision correction procedures such as LASIK and PRK and 10% to 15% savings on mail-order contact lenses. TruVision uses TLC Laser Eye Centers as their preferred LASIK provider. TLC has performed over 2 million LASIK procedures and offers a Lifetime Savings Commitment. Zenni Optical: Zenni Optical offers high quality, affordable and stylish prescription eyeglasses direct from the factory to its customers. Members receive 5% off Zenni s already low prices, with complete prescription eyewear starting at only $6.95. Zenni s online store offers over 3,000 frame styles to choose from. You can turn any pair of Zenni eyeglasses into sunglasses, with a wide selection of tinted lenses to choose from. HearPO **: Receive a 40% discount on diagnostic services, including hearing exams, and significant savings on hearing aids. You ll enjoy a 60-day no-risk trial period; one-year follow-up care; a three-year warranty, including coverage for loss and damage; and free batteries (160 cells per hearing aid) all with a lowest-price guarantee. Regence is completely independent from the companies that provide these products and services. Regence does not endorse or guarantee the products and services offered or their effectiveness. Regence reserves the right to change the program at any time without prior notice. 19

22 TruHearing MemberPlus **: Save an average of $890 per hearing aid on a selection of over 90 models from five leading manufacturers. While access to deep MemberPlus savings is normally $108, Regence members can enroll free through Each purchase includes a 45-day money-back guarantee and extended three-year manufacturers warranties, which include one-time loss and damage coverage. All appointments must be scheduled through TruHearing to ensure MemberPlus pricing. There are no MemberPlus primary or guest enrollment fees for residents of Washington state. Beltone Hearing Care **: Receive a free screening, a 25% discount on Beltone hearing aids, a one-year supply of hearing-aid batteries and free follow-up visits and testing. Epic Dental: Purchase smileprotecting supplies at 25% off, including mouthwash, gums, mints and toothpaste. All items contain xylitol, a natural ingredient that fights cavities. Dental Optimizer Lollipops: Now you can put a halt to cavities and tooth decay with cavity-fighting lollipops from the Dental Optimizer. These all-natural lollipops eliminate cavity-causing bacteria, while leaving healthy bacteria intact. Members receive a 15% discount on lollipops and other tooth-friendly snacks. National Allergy Supply: Save 15% on products for non-drug allergy relief, including pillow and mattress encasings, air filtration products, asthma management tools, green cleaning products and personal care products. National Allergy Supply provides discount prices, *Plus the cost of food. Plus the cost of shipping, if applicable. Valid at participating centres. No cash value. One offer per person. Not valid with any other program offers or discounts. Restrictions apply. ** Discounts through HearPO (also includes extended family), TruHearing and Beltone are available to members and their parents and grandparents. 20 outstanding service and a 60-day unconditional return policy with no restocking fees. CHP CAMaffinity Program: As a Regence member, you re eligible for the CHP CAMaffinity Program, which provides a 20% discount on complementary and alternative medicine (CAM) services offered through The CHP Group s growing network of chiropractors, acupuncturists, naturopathic physicians and massage therapists. CHP Active and Healthy: CHP Active and Healthy is the discount program that gets you up, moving, and saving money! With discounts offered by thousands of participating vendors (e.g. health clubs, ski resorts, sporting events, museums, etc.) for a small annual fee, it s your source for great deals on healthy and fun activities. Nautilus, Inc.: Enjoy 10% off and free shipping on a number of home gym products from Nautilus, Inc., including its #1 selling home cardio machine: The Bowflex TreadClimber TC20. Regardless of your fitness goal or level, these products can help you achieve a healthy and fit lifestyle. Take Shape for Life : Save $25 or more on your first month s order! This safe weight management and health program uses clinically proven Medifast products and a personal health coach to provide one-on-one guidance and encouragement. The program helps you lose weight and manage disease and health through nutritional intervention, free access to health care professionals, educational materials, and the Habits of Health system. There are no hidden costs or start-up fees. Jenny : Jenny Fits Your Life! Pick a program that works with you, not against you! MyDays is a flexible, new weight loss choice that gives you the structure you need to stay on track and the freedom to live your life. Each week you can eat five days with Jenny; the other two days you enjoy your own healthy choices. Your consultant will help you find the program that fits your real life. Members can choose one of these discounted offers from Jenny Craig: FREE 30-day Program* 30% off of the Jenny All Access Membership* Safe Beginnings : Save 15% on Safe Beginnings products, including safety gates, cabinet locks, outlet covers, window guards, and many other babyproofing products. CorCell Saving Baby s Cord Blood : Cord blood stem cells are now being used to treat more than 70 diseases, and research is ongoing to find treatments for even more. Regence has partnered with CorCell to offer a $400 discount when you bank your baby s umbilical cord blood. Protect your child or give the gift of cord blood preservation to your grandchild, niece, nephew, friend or other loved one. Everest Funeral Planning and Concierge Service: Save $50 off the enrollment fee for Everest s suite of funeral-planning services. With advisors available 24 hours a day, you ll get the information you need to make informed decisions about all funeral-related issues, within your budget, and with a funeral home of your choice. Banfield Pet Hospital: As a Regence member, you receive a waived enrollment fee for Banfield Pet Hospital s Optimum Wellness Plans, packages of preventive care that include annual blood work, vaccinations, de-worming, unlimited office visits, plus much more. Banfield is the largest veterinary hospital in the world with 800 hospitals in 43 states; most located inside PetSmart TM. Want to learn more? Access member discounts at myregence.com/advantages or regence.com/advantages

23

24 07368_wa / Regence BlueShield