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 Regence BlueShield is offering several different comprehensive plan designs utilizing both their POS and PPO networks. The POS network requires that you choose a primary care physician (PCP) from their Selections Network and to receive the highest level of benefits most care must be accessed via your PCP. The PPO plans provide direct access to all preferred providers within their network Regence has recently introduced their Breakthru plans which features unlimited office visits covered with simply a co-pay (Breakthru 80 & 70 plans) that are not subject to the annual deductible. High deductible catastrophic plans are available in both networks and do not include pregnancy or prescription drug coverage.
Benefit Summaries
Rates
Providers
Enrollment
Dental
Eligibility
To be eligible you must not be eligible for Medicare and be a resident of one of the following counties; Clallam, Columbia, Cowlitz, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Skamania, Snohomish, Thurston, Wahkiakum, Walla Walla, Whatcom or Yakima. Proof of residency must accompany your application, such as a Washington State driver’s license or a current utility bill, with your name and address clearly visible.
Eligible dependents include your spouse and children under age 23 who are primarily dependent upon you for support. Dependents age 23 or older may apply as members for their own plan coverage.
Need Help? 206.448.7878 or 800.987.8199
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Enrollment Forms & Instructions
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Completed enrollment materials must be received in our office on or before 20th of the month to be effective on the first of the following month (e.g., June 20th for July 1st effective date). |
- Complete the Regence’s Enrollment Application form and be sure to include proof of residency information as requested. Only one application is necessary per family and we recommend that you complete the Regence EFT Form so that premium payments are not missed by accident.
- Complete the Standard Health Questionnaire. A separate questionnaire must be completed for each enrolling family member unless:
- COBRA: The applicant has exhausted all COBRA or other continuation coverage. A copy of a HIPAA Certificate from the prior carrier is required.
- PROVIDER CANCELLATION: The applicant’s provider has left his or her prior plan’s network and is in this plan’s network.
- RELOCATION: The applicant has relocated within Washington State and the applicant’s prior plan is not available in the applicant’s new location.
- An individual losing group coverage through their employer and is not eligible for COBRA does not have to complete the Standard Health Questionnaire if they’ve had 24 months of uninterrupted active group coverage and apply within 90 days of specific qualifying events. (After June 10, 2004)
- An individual losing coverage due to the cancellation of their group conversion plan does not have to complete a Standard Health Questionnaire. (After June 10, 2004)
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The applicant must apply within 90 days of relocation, provider cancellation, or exhaustion of COBRA in order to have the Standard Health Questionnaire requirement waived. | |
- Submit your Enrollment Application, Standard Health Questionnaire, and Proof of Residency to:
R. L. Evans Company, Inc.
600 Stewart St., Suite 1210
Seattle, WA 98101
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Your Enrollment Application and Standard Health Questionnaire must include an original signature (faxed copy is not acceptable). | |
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FAQ’s
When does my coverage begin?
Because individual applications are subject to health statement review, not all applicants will be approved for coverage with Regence BlueShield. If your application is accepted, you will be notified of your effective date and the amount due for the first period of coverage. If your application is not accepted, you will be eligible for the Washington State Health Insurance Pool and you will be sent information about how to enroll.
Applications must be received by the Evans Company by the 20th or post marked to Regence BlueShield by the 20th of any given month to be considered for an effective date the first of the following month. For example, approved applications postmarked to Regence BlueShield on August 20 would be effective September 1. Approved applications postmarked to Regence BlueShield on August 21 would be effective October 1.
You’ll receive your Individual Plan benefit contract and identification card after your first rate payment has been received.
How do I know if I am eligible for one of Regence's medical plans?
To be eligible to apply for an Individual plan, you must reside in the service area as defined by Regence BlueShield. The service area includes the Washington state counties of Clallam, Columbia, Cowlitz, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Skamania, Snohomish, Thurston, Wahkiakum, Walla Walla, Whatcom and Yakima Counties.
You must also have been a resident within the service area for at least 30 days prior to application. Proof of residency will be requested, such as a Washington state driver’s license or a current utility bill, with your name and address clearly visible.
If you are eligible for Medicare Part A or B, you may not apply for this plan.
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Can I cover my entire family?
Yes. Eligible dependents include your spouse and children under age 23 who are primarily dependent upon you for support. Dependents age 23 or older may apply as members for their own plan coverage.
How do I pay for my plan?
Regence offers the following billing options: monthly, quarterly, semi-annually and annually. Select the option that meets your needs and we will bill you based on your selection.
For your convenience, Regence also offers the option of electronic fund transfer, so your rates can be automatically withdrawn from your bank account and paid to Regence BlueShield. By taking advantage of this option, your payments will be made on time, without the hassle of stamps and envelopes. You’ll have no monthly billing statements and you won’t have to worry about your rate payment even if you’re out of town.
What is a preexisting condition?
A preexisting condition is one for which medical advice was given, for which a health care provider recommended or provided treatment, or for which a prudent layperson would have sought advice or treatment within six months prior to the effective date of coverage.
How long is the preexisting condition waiting period?
Regence BlueShield Individual plans contain a nine-month preexisting condition waiting period. This waiting period excludes coverage for a nine-month period for you and your dependents’ preexisting conditions.
In what cases is the preexisting condition waiting period reduced or waived?
If you had prior health care coverage. The nine-month preexisting condition waiting period will be shortened one day for each day you had creditable coverage under another health plan, provided:
- you were enrolled in comprehensive group or individual coverage at any time during the 63
- or —you or your dependents are seeking coverage because of a change of residence within Washington state and your current medical coverage is not offered in the new area and application is received within 90 days of relocation and you were enrolled at any time during the 63-day period immediately preceding the date of application for coverage;
- or —you or your dependents are seeking coverage because your current health care provider is no longer part of your current carrier’s provider network and is part of the Regence BlueShield Network and application is received within 90 days of your provider leaving your current carrier’s provider network and you were enrolled at any time during the 63-day period immediately preceding the date of application for coverage.
If you are a HIPAA-eligible individual. The nine-month preexisting condition waiting period will be waived if you are eligible as defined by 2741(b) of the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 (42 U.S.C. 300gg-41(b)). A HIPAA-eligible individual is defined as someone:
- who has at least 18 months of prior creditable coverage;
- whose prior creditable coverage was not interrupted by more than 63 days at any one time starting with the most recent period of creditable coverage;
- whose most recent prior creditable coverage was under a group health plan, governmental health plan, or church plan and was not terminated for fraud or nonpayment of rate;
- who is not eligible for coverage under a group plan, Medicare A or B, or Medicaid and does not have other health coverage, and;
- who elected and exhausted any COBRA continuation or similar state extension of coverage, which they were offered.
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Do Regence individual plans offer maternity benefits?
Maternity benefits are available on most comprehensive Regence BlueShield individual plans, see plan benefit summaries for details. Maternity-related care subject to the nine-month preexisting condition waiting period includes, but is not limited to:
- Delivery
- Pregnancy termination
- Complications of pregnancy
- Postnatal care
- Newborn care
The nine-month preexisting condition waiting period is waived for prenatal care for the initial and subsequent exams and periodic visits.
What if I need emergency care?
Any time you believe you are having an emergency, you should go to the emergency room for your care. In accordance with Washington state’s ‘prudent layperson’ law concerning emergency room coverage, if a prudent layperson – that is, a person who possesses an average knowledge of health and medicine and is acting reasonably – would consider the situation an emergency, then your emergency room care will be covered by Regence BlueShield. If you are admitted as an inpatient and the hospital is not on the provider list, please call Regence BlueShield within 24 hours of the emergency (or as soon as you are able).
What individual and family plans cover preventive care?
The Selections $500 and $1,000 plans, Preferred Plan $750, Breakthru 80 and Breakthru 70 have no deductible for preventive care services – just a modest copay at the time of service. The preventive care benefits include routine physical exams and immunizations. If you have a family, you’ll be glad to know that your coverage also includes routine physicals and regular check-ups for you, your spouse and children. Check plan summaries for benefit maximum per member per calendar year.
What plans offer prescription drug coverage?
The Selections $500 and $1,000 plans and Preferred Plan $750 also include Regence BlueShield's Prescription Drug Program, designed to provide you with prescription drug coverage, while helping to reduce your health care costs. You simply present your Regence BlueShield identification card and pay a coinsurance to one of more than 750 participating pharmacies located throughout Washington state. When you present your identification card at one of our participating pharmacies, you’ll be eligible for our ne
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