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Plan changes

On October 1, the Employee Benefit Trust Board of Trustees approved plan changes that take effect January 1. This includes changes to Regence/Asuris and Group Health medical plans.

Regence/Asuris – Office visits

Similar to the Group Health $200 deductible plan, 4 office visits not subject to deductible will be added to both the Regence/Asuris HealthFirst 250 and 500 plans. The deductible is waived, but the coinsurance still applies. This is in addition to the preventive care visit that is covered at 100%.

Regence/Asuris – Chiropractic visit limit

Covered chiropractic visit limits will increase from 10 visits to 15 visits per year on the Regence/Asuris HealthFirst 250 and 500 plans. This will match the visit limits on the Regence/Asuris HealthFirst plan.

Regence/Asuris – Out of pocket maximum

The out-of-pocket maximum on the Regence/Asuris HealthFirst 500 plan will decrease as follows:

  Current Effective 1/1/2016
Individual $6,350 $3,500
Family $12,700 $7,000

Regence/Asuris – Pharmacy co-pay

The pharmacy co-pays on the Regence/Asuris HealthFirst 250 plan will change as follows including the addition of a specialty drug tier:

  Current pharmacy Effective 1/1/2016 pharmacy
Generic $4 $5
Preferred brand $15 $25
Non-preferred brand $35 $50
Specialty Non-preferred brand included specialty meds $100

Mail order prescriptions available at 2x the copay for a three month supply. Specialty drugs are prescriptions medications that require special handling, administration or monitoring. These drugs are used to treat complex and chronic conditions and usually are extremely costly.

Regence/Asuris and Group Health High Deductible Health plans

The ACA includes a requirement for an individual out of pocket maximum when an employee is enrolled as a family. The individual out-of-pocket maximums for those enrolled as a family are effective January 1, 2016.

Individual out-of-pocket maximum when enrolled as a family:
Regence/Asuris: $5,000
Group Health: $3,750

Regence/Asuris – Supplemental dialysis program

Regence BlueShield offers a supplemental dialysis program which provides a solution to reduce End Stage Renal Disease (ESRD) claim costs, for both the patient and the Trust. This program will be implemented for all Regence/Asuris plans except the High Deductible Health Plan. It cannot be implemented on this plan due to the mandatory deductibles in place on this plan.

Kidney dialysis patients eligible for this program will be contacted by Regence to discuss enrollment and benefits of this optional program.

Long-Term Disability

Starting January 1, 2016, the Trust will offer a lower rate plan for employers not insuring “high risk professions” (transit, police or fire) personnel. The benefits will mirror the current plan options, but the premiums are 18% lower than our current LTD rates.

If high-risk professions are insured on Trust LTD plans, then the employer is not eligible for the lower rate plan for any employees.

Employers that qualify for the lower rate must contact Trust staff. If the employer does not contact Trust staff, premiums will not be reduced. Once it is determined the employer qualifies for the lower rate, Trust staff can start the transition to the lower premiums.