Regence

IAFN Bronze 8000 POS

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $8,000 Family: $16000 Per Person: $8000
Combined Medical and Drug Out of Pocket Maximum	Individual: $9,200 Family: $18400 Per Person: $9200

Office Visit

Primary Doctor	CoPay: $60.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Virtual Care (Telehealth) Visit $10 Copay. See policy for more information.
Specialist	CoPay: $100.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: Virtual Care (Telehealth) Visit $10 Copay. See policy for more information.

Prescription Drug Information

Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 30.00% Coinsurance after deductible Covered: Covered Benefit Explanation: Insulin limit of $100 for a 30 day supply and $300 for 90 day supply. See policy for more information.
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered Benefit Explanation: See policy for more information.
Generic Drugs	CoPay: $20.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: See policy for more information.
Specialty Drugs	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Limit Quantity: 30 Limit Unit : Item(s) per Month Benefit Explanation: See policy for more information.

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Benefit Explanation: See policy for more information.
Inpatient Services	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Benefit Explanation: See policy for more information.

Emergency and Urgent Care

Emergency Room	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Benefit Explanation: See policy for more information.
Urgent Care Facility	CoPay: $100.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: See policy for more information.

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Benefit Explanation: See policy for more information.
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered Benefit Explanation: See policy for more information.

Vision

Routine Eye Exams for Children

CoPay: No Charge
CoInsurance: No Charge
Covered: Covered
Limit Quantity: 1
Limit Unit : Exam(s) per Year
Benefit Explanation: See policy for more information.

Major Dental Care

Routine Dental Checkups for Children	CoPay: No Charge CoInsurance: No Charge Covered: Covered Limit Quantity: 2 Limit Unit : Exam(s) per Year Benefit Explanation: See policy for more information.
Routine Dental Checkups for Adults	Covered: Not Covered
Basic Dental Care - Adult	Covered: Not Covered
Basic Dental Care - Child	CoPay: Not Applicable CoInsurance: 20.00% Covered: Covered Limit Quantity: 2 Limit Unit : Exam(s) per Year Benefit Explanation: See policy for more information.
Major Dental Care - Adult	Covered: Not Covered
Major Dental Care - Child	CoPay: Not Applicable CoInsurance: 50.00% Covered: Covered Benefit Explanation: Quantitative limits apply. See policy for more information.