PPO-Regence Blue Shield Preferred Provider Health Plans

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Preferred (PPO) Plans

Preferred Plans are typically listed two ways. For example:

80/80/50 for a plan without a copay OR
100/90/60/15 for a plan with a copay

The first number refers to the coverage (i.e., 80%) for professional services provided by a Preferred Plan provider, including office visits.

The second number refers to coverage (i.e., 80%) for Preferred Plan hospital facilities.

The third number refers to the coverage for most services (i.e., 50%) for participating (Non-Preferred Plan) providers.

The fourth number refers to the copay (i.e., $15) for office visits.

Summaries of Benefits

You can post the following summaries on your company's Intranet site. However, we encourage you to link directly to our site since these documents are subject to change. If you need help doing this, please send an email to wa_info@regence.com.

MEDICAL PLANS

Eff. 1/1/2010 and Beyond	Eff. 10/15/2009 and Beyond	Eff. 1/1/2009 to 10/14/2009
100+ Employees Regence HSA Healthplan Preferred Plan 80/80/50 Preferred Plan 100/90/60/15 Preferred Plan 100/90/60/15 with Deductible Waiver Preferred Plan 100/90/60/20 Preferred Plan 100/90/60/20 with Deductible Waiver Preferred Plan 100/90/60/25 Preferred Plan 100/90/60/25 with Deductible Waiver Preferred Plan FourFront - $15 Copay Preferred Plan FourFront - $25 Copay	51+ Employees Regence HSA Healthplan Preferred Plan 80/80/50 Preferred Plan 100/90/60/15 Preferred Plan 100/90/60/15 with Deductible Waiver Preferred Plan 100/90/60/20 Preferred Plan 100/90/60/20 with Deductible Waiver Preferred Plan 100/90/60/25 Preferred Plan 100/90/60/25 with Deductible Waiver Preferred Plan FourFront 15 Preferred Plan FourFront 25 1-50 Employees Regence HSA Healthplan Preferred Plan 80/80/50 Preferred Plan 100/90/60/15 Preferred Plan 100/90/60/15 with Deductible Waiver Preferred Plan 100/90/60/20 Preferred Plan 100/90/60/20 with Deductible Waiver Preferred Plan 100/90/60/25 Preferred Plan 100/90/60/25 with Deductible Waiver Preferred Plan FourFront 15 Preferred Plan FourFront 25	1-50 and 51+ Employees Regence HSA Healthplan Preferred Plan 80/80/50 Preferred Plan 100/90/60/15 Preferred Plan 100/90/60/15 with Deductible Waiver Preferred Plan 100/90/60/20 Preferred Plan 100/90/60/20 with Deductible Waiver Preferred Plan 100/90/60/25 Preferred Plan 100/90/60/25 with Deductible Waiver Preferred Plan FourFront 15 Preferred Plan FourFront 25



Exclusions and Limitations	Benefit Options for Traditional, Selections & Preferred Plans (except FourFront, HSA-Qualified Preferred Plan 80/80/60 and Regence HSA Healthplan) Benefit Options for Preferred Plan FourFront Benefit Options for Regence HSA Healthplan Exclusions and Limitations	Benefit Options for Traditional, Selections & Preferred Plans (except FourFront, HSA-Qualified Preferred Plan 80/80/60 and Regence HSA Healthplan) Benefit Options for Preferred Plan FourFront Benefit Options for Regence HSA Healthplan Exclusions and Limitations

The benefit information contained in the documents above is effective on the date stated on the bottom of each document. For renewing groups, benefit changes are effective upon the group's renewal unless otherwise stated. Note: To print a PDF document, you need Adobe^® Reader^®. Download it now for free.


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