Asuris NW Health
| Individual | Family | What you should know | |
|---|---|---|---|
| Annual Deductible (choose one; based on calendar year) |
$2,000 or $3,500 | $4,000 or $7,000 no one family member is eligible for benefits until the entire family deductible is met. |
Your deductible is the dollar amount you pay in a calendar year before the plan pays covered benefits. Not all benefits apply toward the deductible. Some benefits require a copay or other cost-sharing amount. |
| Annual Coinsurance Maximums | $5,000 Out of pocket maximum | $10,000 Out of pocket maximum | For the Asuris Emerge HSA Plans, the out of pocket maximum includes the deductible. |
| Annual Benefit Maximum | $2,000,000 | This is the highest dollar amount we will pay toward essential benefits in a calendar year. | |
| Percentages and copays shown are what you pay for each covered event. The percentages shown are what you pay after you have met your deductible, unless otherwise noted. | Provider Type | Category 1 With Preferred providers, you’ll generally have lower out-of-pocket costs. Category 2 With Participating providers, you’ll generally pay more out of pocket than with providers in Category 1. Category 3 With Non-contracted providers, you’ll have the highest out-of-pocket costs and they may bill you for the balance over our payment of the claim. |
|
| Category 1 (100% coverage) |
Category 2 & 3 (100% coverage) |
||
| Office Visits | 20% | 40% | Copay applies only to the office exam. All other services provided during the visit are subject to the applicable deductible and coinsurance |
| Prescription Medication | 20% after medical deductible is met for generics only except for brand medications required by law. Retail or Mail Order: Up to 90 day supply for covered prescription medications | You continue to receive discounts off the full retail price of medications through the RegenceRx discount program. Just show your member card at your pharmacy. We cover certain preventive medications according to United States Preventive Services Task Force (USPSTF) guidelines at 100%, no deductible, no copay at participating pharmacies only. Member must have a prescription. | |
| Preventive Care and Immunizations (not subject to deductible) |
Category 1 and 2: 0% Category 3: Regular plan benefits and deductible apply | Covered according to federal preventive guidelines. | |
| Outpatient Radiology and Laboratory (limit does not apply to preventive care or complex outpatient imaging) |
20%;subject to deductible | 40%;subject to deductible | |
| Vision Care | Excluded | Excluded | |
| Spinal Manipulations | 20% | 40% | 10 spinal manipulations per calendar year |
| Acupuncture | 20% | 40% | 6 visits per calendar year |
| Ambulance | 20% | 40% | |
| Emergency Room | 20% | 40% | |
| Complex Outpatient Imaging | 50% | 50% | |
| Maternity Care | Excluded | Excluded | |
| Durable Medical Equipment | 20% | 40% | |
| Hospitalization | 20% | 40% | |
| Mental Health Treatment | 20% | 40% | |
