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(Available to Washington State Residents Only)
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SUMMARY OF BENEFITS
BALANCE 1250
FOR INDIVIDUALS & FAMILIES
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BALANCE 1250 - THE MOST COVERAGE - Alliant Plus Network
The Balance 1250 Plan - '10 is great for those who want total peace-of-mind. Maternity coverage is included, so this is a good plan if you're adding to your family. Your deductible is lower than any other Balance plan, and it doesn't apply to preventive care office visits, and to most in-network office visits. So you get a lot of coverage without first having to meet your deductible.
These plans let you choose between the Alliant Plus in-network and out-of-network options, with different levels of coverage. In-network care includes access to the more than 1,000 Group Health doctors and clinicians, and also includes the thousands of contracted community providers and the many doctors who practice with Virginia Mason and The Everett Clinic. Out-of-network care includes services from any other doctor, anywhere with discounted care from First Choice Health and Beech Street providers. Click here to look up a provider.
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Benefits |
Alliant Plus
In-Network |
Alliant Plus
Out-Of-Network |
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Annual Deductible |
$1,250 per member or $3,750 per family
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Memeber Coinsurance |
20% |
20% |
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Out-Of-Pocket Limit*
(Deductible does not apply.)
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$5,000 per member or $15,000 per family
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Benefits |
No Deductible |
After Deductible,
Member Pays |
Office Visits
Including mental health outpatient services.
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$30/visit |
$30/visit |
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Manipulative Therapy
Limit total visits PCY** to 10 combined for both in- and out-of-network.
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$30/visit,
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$30/visit,
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Acupuncture
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$30/visit,
up to 8 visits PCY |
$30/visit |
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| Naturopathy |
$30/visit,
up to 3 visits PCY |
$30/visit |
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Maternity Care
Outpatient non-routine prenatal and postpartum visits. Copay waived for routine care.
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$30/visit |
$30/visit |
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Benefits |
After Deductible, Member Pays |
Hospital Visits - Inpatient
Hospital room and board; inpatient surgery; anesthesia, intensive and coronary care; laboratory test; radiology services; drugs while in hospital. Includes mental health inpatient treatment and maternity care (delivery and associated hospital care).
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$200 per day up to 5 days/admit + 20% |
$200 per day up to 5 days/admit + 20% |
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Lab/X-Ray Services
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Deductible waived on first $500 PCY, then deductible and 20% apply. |
20% |
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Devices, Equipment & Supplies
(DME and prosthetics.)
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DME — 50% up to $5,000 in charges
($2,500 max. benefit PCY);
Prosthetics — 50% up to $40,000 in charges
($20,000 max benefit PCY) |
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Emergency Care
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$100 + 20% |
$100 + 20% |
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Benefits |
Deductible Does Not Apply |
Preventive Care Visits
For children and adults; including physicals and immunizations, as established in Group Health's well-care schedule.
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Covered in full |
$30/visit
$300 individual/
$600 family annual
benefit maximum |
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Prescription Drugs
Outpatient: Drugs and medicines that require prescription, including self-administered injectables, contraceptive drugs, devices, and supplies. $3,000 annual maximum combined for in- and out-of-network.
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$10 generic
30% brand name
50% non-formulary
Mail order: $5 discount
for 30-day supply |
$15 generic
30% brand name
50% non-formulary |
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Vision Care
$200 hardware benefit per 12 months.
Not subject to coinsurance.
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$30 for routine
eye exam per 12 months |
Covered up to $30 for routine eye exam per 12 months |
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* Member coinsurance and emergency care copayment apply to out-of-pocket limit.
** PCY = per calendar year
Note: This is a summary of benefits. The contents are not to be accepted or construed as a substitute for the provisions of the master policy or agreements. Other terms and conditions apply. All plans cover on-the-job-injury-related health care costs for partners, proprietors, or corporate officers who are not covered by a workers' compensation act, subject to the plan's cost shares and benefit limitations.
Coverage provided by Group Health Options, Inc.
E-mail us for more information and a free quote or CALL TOLL FREE
1-800-875-4490 (in the U.S.)
or 1-253-854-0199 (outside the U.S.)
Fax: 1-253-896-9411
Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424
Serving all of Washington at 800-875-4490, Seattle at 206-682-1628,
Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291.
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