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) WiseChoices 20 - Summary of Benefits All services subject to plan's deductible, unless otherwise noted. Coinsurance is 20%. PCY = Per Calendar Year Coinsurance and copay represent WHAT YOU PAY. MEDICAL PLAN Preferred Provider Non-Preferred Provider Annual Deductible PCY (choose one)> $1,0000 Individual or $3,000 Family $3,000 Individual or $9,000 Family Coinsurance (what you pay) 20% 50% Annual Coinsurance Maximum $8,500 Individual or Family = 3x Individual Unlimited Out-of-Pocket Maximum (deductible + coinsurance maximum) $9,500 Individual or Family = 3x Individual Unlimited COVERED SERVICES Lifetime maximum $2 million   Office Visits including Urgent Care & Naturopathy DEDUCTIBLE WAIVED $30 Copay 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 Pharmacy - Retail (30-day supply) Brand: $3,000 PCY limit; Generic: Unlimited $10/$45/50% Preferred network cost + 40% Pharmacy - Mail Service (90-day supply) Brand: $3,000 PCY limit; Generic: Unlimited $25/$112.50/45% Outpatient Diagnostic Imaging & Lab Services Deductible, then 20% Deductible, then 50% Mammography DEDUCTIBLE WAIVED then 20% Emergency Room Care Copay waived if direct admit to an inpatient facility $100 copay, then subject to deductible, then 20% $100 copay, then subject to deductible, then coinsurance** Ambulance Transportation Air: unlimited; Ground: $5,000 PCY limit Deductible, then 20% Deductible, then coninsurance** Outpatient & Inpatient Facility Care 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) 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 20% 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 Deductible, then 20% Deductible, then 50% Vision Care - Routine Exam (One exam per two calendar years) Covered in Full Covered in Full Vision Care - Hardware (Per two calendar years) $200 for frames, lenses & contact lenses $200 for frames, lenses & contact lenses Mental Health - Outpatient Office Visit (6 visits PCY) DEDUCTIBLE WAIVED $30 Copay Deductible, then 50% Mental Health - Inpatient Facility Care (6 visits PCY) Deductible, then 20% Transplants (12-month waiting period; $250,000 lifetime benefit) Organ & Bone Marrow 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. ** 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© 1998-2007, Maddock & Associates  |  Privacy Statement Problems viewing this page? Contact the webmaster.