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Contact us
8am - 6pm(Pacific)
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Contact us
8am - 6pm(Pacific)
Monday - Friday
| Schedule of Benefits | |
|---|---|
| Annual Maximum (all expenses) | $20,000 |
| Annual Individual Deductible | $200 |
| Annual Family Deductible | $500 |
| Inpatient Benefits | |
| Coinsurance percentage paid by the plan | 80% |
| Room and Board, per day | $500 |
| Intensive Unit, per day | $1,000 |
| Other hospital services annual maximum | $3,000 |
| Outpatient Benefits | |
| Maximum (all outpatient expenses) | $3,000 |
| Doctor's office co-pay | $15 |
| Percentage of doctor's bill paid after co-pay | 100% |
| Diagnostic, Surgical Service, & Emergency Room Visits | 80% |
Prescription Card
| Carrier | ACE |
|---|---|
| Plan Processor | Regence Rx |
| AM Best Rating | A+ |
| Pharmacy Plan | Generic Coverage 96% of top name-brand drugs included |
| Maximum Monthly Benefit | $200 Individual $400 Family |
| Annual Deductible | $0 |
| COPAYMENT Generic (the lesser of) |
$10 or the pharmacy's usual and customary |
| Preferred Brand | Network discounted drug prices or the pharmacy's usual and customary, whichever is less |
| Non-Preferred Brand | Network discounted drug prices or the pharmacy's usual and customary, whichever is less |
| Brand-Name Drugs in excess of $100 | Could be obtained for free in some instances through Patients Pharmacy Assistance Program |
| Non-Covered Drugs | Network discounted drug prices or the pharmacy's usual and customary, whichever is less |
| Network | More than 52,000 locations nationwide - 100% of chain-store pharmacies and 91% of independent stores participating |
| Mandatory Generic | Yes |
| Mail Order | 90-day supply |
| Online Information available at http://www.RegenceRx.com |
Pharmacy locator Preferred Medication list Rx Price Guide Generic Medications Link to mail-order service |
