Your Medical & Behavioral Health Benefits

The Medical Plan is administered by Regence BlueCross BlueShield of Oregon. You have the flexibility to choose any provider (doctor, hospital, or service). However, you’ll pay less if you use a Regence in-network provider. 

If you are a Medicare-eligible Retiree who is enrolled in the Trust’s fully-insured Plan through Regence, please click here to learn more about your Plan benefits.

To find a Regence in-network provider, go to Regence.com, sign in and click “Find a Doctor.”

• In-network providers do not charge more than the Plan’s allowed amount, so you won’t get billed for any charges above what the Plan pays. Regence has two types of in-network providers:
  » Preferred Providers (you will pay the least)
  » Non-Preferred Participating Providers (you will have more options but may pay more)
• If you use an out-of-network provider (Non-Preferred, Non-Participating Provider), you’ll pay the most, because they may charge more than the Plan’s allowed amount and bill you for the difference (this is called balance billing). You are responsible for paying any amount over Plan’s the allowed amount, and it can be substantial. For certain kinds of out-of-network services, a federal law called the “No Surprises Act” limits the amount you will pay and prohibits the out-of-network provider from balance billing you. Contact Regence or the Trust Administrative Office if you have questions regarding the No Surprises Act.

TIP: An in-network provider may refer you to an out-of-network provider for services (such as lab work, tests and imaging). Ask if the provider is in-network before you get any services.

Medical Plan Payment Example

Health Care Options

Choose the right kind of care for your health care needs:

• Preventive care: Detect serious health concerns early, when they are most effectively treated. The Active Employee Plan pays 100% for preventive services and cancer screenings required by the Affordable Care Act.
• In-person doctor visit. When you need to be seen in person for a physical exam or to get tests, schedule an office visit. 
• Virtual care: A doctor can diagnose most acute illnesses and prescribe medication via a virtual visit. MDLIVE gives you 24/7 virtual access to a doctor by phone, secure video, or the MDLIVE app. There is no cost to you. Click here for details.
• Regence telemedicine: Your regular providers may offer telehealth (phone or online) visits. The Plan covers these the same as an in-person office visit.
• Urgent care: For an issue that is serious, but not life-threatening (a broken bone or cut that needs stitches), an urgent care clinic may be a good choice.
• Urgent care that comes to you. From flus and fevers to blood tests and stitches, DispatchHealth sends a professional medical team to you for in-home care. The Plan covers this service as an in-network provider. Click here for details.
• Emergency care: When it’s life or death, call 9-1-1 or go to the nearest appropriate facility (physician's office, clinic setting, urgent care center, or hospital emergency room).
  » If you receive emergency care from an out-of-network provider or facility, the “No Surprises Act” protects you from being “balance billed” for the difference between what the Plan pays and what the facility charges.

Behavioral Health Care

Your benefits give you options for confidential, professional behavioral health care.

• A medical doctor can rule out any physical causes and prescribe medication, if appropriate.
• Qualified behavioral health providers, such as a psychiatrist, psychologist, or licensed therapist, are covered by your Medical Plan. For help choosing the right provider for you:
  » Sign in to your account on Regence.com to chat online, 
  » Call the number on the back of your member ID card, or 
  » Search for an in-network provider.

• Schedule a virtual visit (by phone or online video chat). Talk with a counselor from the privacy of your own home when it’s convenient for you. Go to MDLIVE.com/regence-or, download the app on your smartphone, or call (888) 725-3097. There’s no cost to you.
• Suicide Prevention Lifeline: Dial or text 988 if you or someone you know is having thoughts of suicide. You can also get free resources to help someone at suicidepreventionlifeline.org. 

Medical Plan Annual Deductible

Every year, starting on January 1, you must pay for all covered services until your payments add up to the annual deductible amount. These payments include your share of costs up to the Plan’s allowed amount, but do not include any balance-billed charges, your monthly contribution, or services the Plan doesn’t cover. You do not have to meet your deductible for the Plan to pay for certain covered services. Please refer to the Active Employee Plan SPD for information regarding which covered services are not subject to the deductible and for information regarding the deductible carryover.

When you have paid the annual deductible, the Plan starts to pay benefits at the applicable coinsurance percentage for the services you receive. 

Here’s how the family deductible works for Active Employees (there is no Family Deductible for Non-Medicare Retirees):

• When a covered family member has paid their individual deductible, the Plan begins to pay for covered services for that person.
• When the combined amount of the individual deductibles paid by three or more covered family members meets the family deductible amount for that calendar year, the Plan begins to pay for all family members, even if there are family members who have not paid their individual deductible. A family member may not contribute more than the amount of the individual deductible towards the family deductible.

See your annual deductible balance at regence.com; sign in to your account, click My Plan, then Check benefits and coverage.

Medical Plan Coinsurance

After you have paid the annual deductible amount, the Plan pays a share, and you pay a share, for the covered services you receive. The Plan pays 100% for certain covered services. The percentage the Plan pays is based on the provider you choose (see examples above) and the service you receive.

The Plan’s payment is based on the amount that is allowed by the Plan (not what the provider charges). 

• An in-network provider (Preferred and Non-Preferred Participating Provider) does not charge more than what the Plan allows, so you won’t get a bill for the difference.
• An out-of-network provider (Non-Preferred, Non-Participating Provider) may charge more than what the Plan allows. If the out-of-network provider bills you for an amount over what the Plan allows, you are responsible for 100% of the difference between what the provider charges and what the Plan pays. Be aware that these out-of-pocket costs can be substantial. The No Surprises Act provides protection to you from these bills for certain kinds of out-of-network services.

Medical Plan Out-of-Pocket Maximum

The out-of-pocket maximum is the most you will have to pay in a year for covered services. Once you pay this amount, the Plan pays 100% for all covered services for the rest of the calendar year.

Here’s how the Family Out-of-Pocket Maximum works for Active Employees (there is no Family Out-of-Pocket Maximum for Non-Medicare Retirees):

• When a family member has paid the individual out-of-pocket maximum amount, the Plan begins to pay 100% for that person’s covered services for the rest of the year.
• When the combined amount paid by the family reaches the total family out-of-pocket maximum amount, the Plan begins to pay 100% for covered services for all family members for the rest of the year, even if there are family members who have not paid their individual out-of-pocket maximum.

What you pay for coinsurance or copayments is applied to your out-of-pocket maximum, but what you pay towards any charges above the Plan’s allowed amount from out-of-network providers, your monthly contribution for coverage, or non-covered services are not applied to your out-of-pocket maximum.

See your annual out-of-pocket balance at regence.com; sign in, click My Plan, then Check benefits & coverage.

Medical Plan Pre-Authorization

Pre-authorization means getting approval for certain services or supplies before they are provided. This process ensures you are getting safe, effective, and appropriate treatment. 

When pre-authorization is required, you must receive approval before you receive the service or supply. If you don’t, the Plan may not cover those costs and the doctor may bill you for the full cost. 

A Regence in-network provider will obtain pre-authorization for you when it is required. If you use an out-of-network doctor, you may need to request pre-authorization yourself.  

Get all the details at regence.com; sign in to your account, click My Plan, then Check benefits & coverage. You may also contact the Regence Customer Service Department at (800) 245-9272.

Medical Benefits Overview

Active Employee Plan

This is an overview of commonly used services. For benefit details, please refer to the Active Employee Plan Summary Plan Description. 

Retiree Plans

Non-Medicare Retirees: Please refer to the Retiree Plans Summary Plan Description to view benefit details for your Plan.

Medical Plan Additional Programs

Your Medical Plan gives you access to these programs at no cost to you:

Livongo Diabetes Care: Participants use a glucose meter that sends data to Livongo, and based on their results, receive support from expert coaches to improve health outcomes (all at no cost to you). Plus, free test strips are automatically delivered to your home. Click here for details (registration code: BLEDSOE).

‍NEW! Hinge Health Digital Physical Therapy: Through Hinge Health, participants 18 years and older can conquer non-work related joint and muscle pain with digital exercise therapy specifically tailored to their needs—all from the comfort of home. You’ll receive real-time feedback in the Hinge Health app while performing the exercises. And a personal coach and a physical therapist will connect with you to help keep you on track. Best of all, there’s NO cost to you! Click here to get started or call (855) 902-2777.

Tobacco Cessation Program: Free & Clear^® Quit for Life^® program offers one-on-one coaching and free nicotine replacement therapy. It is available to participants 18 years and older. Click here for details.

Regence Empower: This program can help you start a fitness routine, lose weight, improve your sleep, and reach other healthy goals. Click here for details.

Regence Condition Manager: For participants with a chronic conditions (such as diabetes, heart disease, asthma and/or depression), this program provides one-on-one assistance from health care professionals who provide extra support in addition to your doctor’s treatment plan. Click here for details.

Regence Care Management: For cases of serious illness or injury with the potential for major continuing expense, this program helps patients obtain the best benefit coverage. Click here for details.

‍Regence BlueCard Worldwide® Program: If you need medical assistance services outside of the United States (including locating a doctor or hospital), contact the Regence BlueCard Worldwide Service Center at (800) 810-BLUE (toll free) or collect at (804) 673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange care for covered medical services. While there is no cost to use this, when you receive care from providers outside of the United States, you will typically have to pay the providers and submit claims for reimbursement of any covered services received.