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Frequently Asked Questions
by Individual and Family Plan Members
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What you need to know.
What is a comprehensive plan?
These plans are designed to provide a high level of protection for most major and minor medical expenses, including prescription drugs, maternity and preventive care.
What is a catastrophic plan?
Catastrophic coverage is ideal for people who are looking for protection from an unforeseen, serious accident or medical emergency. Catastrophic coverage is an affordable way to protect yourself from large, unplanned medical expenses. It usually has a high deductible and doesn’t cover routine medical care.
What is coinsurance?
Coinsurance is your share of the cost of health care services after you’ve met your deductible and paid any applicable copay. For example, if your plan pays 80%, the remaining 20% is your coinsurance. Coinsurance amounts can vary from plan to plan.
What is an allowed amount?
An allowed amount is the fee that most providers agree to accept as payment in full for covered services. (Any deductible, coinsurance or copay is part of your share of the allowed amount.)
What is a coinsurance maximum?
Standard (non-HSA) plans have a coinsurance maximum, which is the most you would pay in coinsurance in a calendar year. Only your coinsurance counts toward this limit; money you pay in copays or toward the deductible does not accumulate toward this maximum. You would still be responsible for non-coinsurance out-of-pocket expenses, such as office-visit copays, after this maximum is reached.
How does the HSA annual out-of-pocket maximum work?
Your out-of-pocket maximum is the limit to how much you would pay out of pocket during a calendar year. Coinsurance and deductibles both count toward this maximum. This amount varies by plan. After you have reached your out-of-pocket maximum, Regence pays 100% of remaining covered medical expenses for that calendar year.
How does the deductible work?
Your deductible is the cost of covered medical services you incur and are responsible to pay each calendar year before the benefits are available. On standard plans, the family deductible is met when three or more covered family members reach the equivalent of three individual deductible amounts. On HSA family plans, the entire family deductible needs to be met before any family member receives benefits. (On HSA individual plans, an individual needs to meet just their one deductible.)
What is a Consumer-Directed Health Plan?
It’s a health plan design that involves consumers more directly in their health care through higher cost-sharing. Typically, such products are paired with a tax-advantaged health savings account offered through a bank. Funds in this account can be used to cover a portion of out-of-pocket expenses or saved for future medical needs.
What is a pre-existing condition?
By pre-existing condition, we mean a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received or for which a prudent layperson would have sought medical advice, diagnosis, care or treatment, within the 6-month period before the effective date of coverage. The exclusion period will end 9 months following your effective date of coverage.
Frequently asked questions
Going to our Web site, www.regence.com, is the quickest and easiest way to apply. We’ve even built some decision-making tools that can help you choose the plan that’s right for you. You can also complete and submit the application form that’s at the back of this booklet. To help you through the application process, here are some frequently asked questions:
Who can apply for coverage?
Individuals and families who are not eligible for Medicare can apply for coverage under these plans if they reside in Washington. Eligible family members may include your spouse or domestic partner, and any unmarried dependent children under age 25.
Can I apply online?
Yes, you can apply online. Online shopping is quick and easy. Compare plans, get a rate quote, find participating doctors and hospitals, and complete an application online. Our Web site makes it easy to find or match a doctor and hospital to the plan you’re considering. How do I apply on paper?
Simply complete the enclosed application (one per family). Then return the forms to us. Once we receive all the needed documents, we’ll begin our review process. By completing the application, will I automatically be approved for coverage?
Washington state requires a Standard Health Questionnaire to be used by all carriers that sell Individual health coverage in the state. The standardized scoring method determines whether an applicant is eligible for coverage with us or with the state’s high risk pool. When will my coverage begin?
Your contract will be effective on the first of the month after your application is approved. Applications that are received by 5 p.m. on the last business day of the month (if approved) will be eligible for an effective date the first of the following month. You’ll receive your contract and member card after we receive your first payment.
Does it cost more to buy through an agent?
No. There is never an extra cost or obligation when you use an appointed agent. Agents appointed to represent Regence products provide a valuable service to their clients. They can help you decide which of our products is best for you and your family.
What about prior coverage credit?
If we receive your application within 63 days after similar coverage with another insurance carrier ends, we’ll credit the time you were covered by the other company to the nine-month pre-existing condition waiting period. We need to receive a copy of your Certificate of Coverage from your previous insurance carrier in order to apply credits.
Creditable coverage means any of the following types of coverage:
•Group coverage (including FEHBP and Peace Corps)
•Individual coverage (including student health plans)
•Medicaid
•Medicare
•CHAMPUS/Tricare
•Indian Health Service or tribal organization coverage
•Public health plans
•State Children’s Health Insurance Program (S-CHIP)
•State high-risk pool coverage
•Self-funded government plans
How do I pay for my plan?
Choose from three convenient billing options: monthly automatic bank deduction (SurePay), quarterly billing, or monthly paper billing. Don’t send money with your application. We’ll bill after we’ve processed your application.
If you choose monthly automatic bank deduction, it may take a month or two to get your bank deduction set up. So, please be sure to pay the monthly bills that you receive in the mail until the bank deduction is finalized.
What if I want to add a dependent in the future?
You may add a dependent at any time, but the enrollment date may vary. If you add a newborn or recently adopted child to your policy within 60 days of birth, adoption or placement for adoption, the enrollment date is the date of birth, adoption or placement for adoption. See your contract for details.
To add a spouse, domestic partner or child after your effective date, send us a completed application form. Once we receive the application, we’ll begin the review process. You can also apply online at www.regence.com.
If the dependent’s application is approved, benefits for pre-existing and other specified conditions will be subject to limitation periods.
Can I purchase the dental options separately from the medical plans?
No. The Evolve dental options are available only to individuals and families who purchase Regence Evolve medical plans during initial enrollment. If you want a stand-alone dental plan (one that’s not combined with medical coverage), please visit Regence Life & Health Insurance Company at www.regencelife.com. Can individual family members decline dental coverage?
If more than one family member is applying for a health plan and dental options on the same application, all family members will have the dental coverage. If individual family members complete separate applications for medical coverage they can choose to add or not add a dental option.
What should I do if I have questions?
This booklet is a summary of the Regence Evolve plans. You may find it useful if you need a quick answer to a question about your coverage. The policy will provide complete details about your plan.
Please call us at 1 (888) REGENCE (1-888-734-3623) if you have more questions before you’ve been accepted for coverage. Once your coverage is effective, please call Customer Service at 1 (888) 232-5763. The TTY line for people with a hearing impairment is 711. If you prefer, an insurance producer appointed to represent our products can also answer questions and help you apply.
For the most up-to-date list of medical providers, please visit our Web site at www.regence.com, and choose Find a Provider.
Can my employer pay for my coverage?
No. Individual plans are not intended for sale as an employer-sponsored health plan for employees. You’re required to certify on your application for Individual coverage that your employer is not paying for your plan. For information on employer health benefit plans, contact our Group Sales department.
How do I know if my doctor is covered?
You may see any of our contracted providers. For a list, visit our Web site at www.regence.com. Simply click on Find a Provider at the top of the page and follow the prompts. You will see all the networks the providers are part of as well as other useful information (such as location, hours and languages spoken).
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