Regence BlueShield   LifeWise of WA   Group Health   Comprehensive Plans     Balance 1750     Welcome 750   Catastrophic Plans     Balance 2500     Balance 5000     Welcome 2000     Welcome 3500   HSA Plans     HealthPays HSA 2000     HealthPays HSA 2750   Plan Rates   Apply Now!   Provider Directories   Exclusions &    Limitations   HSA Plans   Individual Dental   Group Medical   Group Dental   Grp Life & Disability   About the Plan   Premiums   Application   (Available to Washington State Residents Only) SUMMARY OF BENEFITS BALANCE 1750 FOR INDIVIDUALS & FAMILIES BALANCE 1750 - Alliant Plus Network If choice is first and foremost, the Balance plans are for you because you can see any doctor you want for primary, specialty, and alternative care. These plans let you choose between the Alliant Plus in-network options, with different levels of coverage. Structured like traditional copayment plans, you'll pay a fee for your in- and out-of-network office visits. For some benefits (in- or out-of-network) your coinsurance won’t apply until after you pay your deductible. And, your deductible doesn’t apply to preventive care office visits, and to most in-network office visits, which is a whole lot of value. Click here to look up a provider. Benefits Alliant Plus In-Network Alliant Plus Out-Of-Network Annual Deductible $1750 per member or $5,250 per family Memeber Coinsurance 20% 40% Out-Of-Pocket Limit* (Deductible does not apply.) $6,000 per member or $18,000 per family Benefits No Deductible After Deductible, Member Pays Office Visits Primary: $30/visit Speciality: $50/visit Primary: $30/visit + 40% Speciality: $50/visit + 40% Manipulative Therapy Limit total visits PCY** to 10 combined for both in- and out-of-network. $30/visit $30/visit + 40% Acupuncture $30/visit, up to 8 visits PCY $30/visit + 40% Naturopathy $30/visit, up to 3 visits PCY $30/visit + 40% Maternity Care Outpatient non-routine prenatal and postpartum visits. Copay waived for routine care.      $30/visit                          $30/visit + 40% Delivery & asociated care covered at hospital inpatient cost share. 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. $300 per day up to 5 days/admit + 20% $300 per day up to 5 days/admit + 40% Lab/X-Ray Services Deductible waived on first $400 PCY, then deductible and 20% apply. 40% Devices, Equipment & Supplies (DME and prosthetics.) 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) Emergency Care $100 + 20% $100 + 20% 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. Covered in full $30/visit + 40% $300 individual/ $600 family annual benefit maximum 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. $15 generic 40% brand name 50% non-formulary Mail order: $5 discount for 30-day supply $20 generic 40% brand name 50% non-formulary Vision Care $30 for routine eye exam per 12 months Covered up to $30 for routine eye exam per 12 months   $200 hardware benefit per 12 months. Not subject to coinsurance or deductible. * Member coinsurance and emergency care copayment apply. No other fees for covered services apply to out-of-pocket limit. ** PCY = per calendar year CARRYOVER: There is no 4th quarter deductible carryover. 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 agreement. 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. Copyright© 1998-2011, Maddock & Associates  |  Privacy Statement Problems viewing this page? Contact the webmaster.