Regence Breakthru is a series of three individual and family products. Each product offers two deductible options along with these great features:

Plan highlights
Regence Breakthru is a series of three individual and family products. Each product offers two deductible options along with these great features:

Office Visits: Unlimited office visits* covered at 100% after the copay (before the deductible)**.
Drugs: Generic prescription drugs paid with a copay (before meeting the deductible). The RegenceRx™ Discount Program is also available.
Preventive Care Benefits: Available with Breakthru 70 and Breakthru 80.
Regence Advantages: Discounts on health club memberships, LASIK surgery, contact lenses, and other services.
*X-rays, lab services and other professional services are subject to the deductible and coinsurance.

**Only on Breakthru 70 and Breakthru 80


Extended Network Benefits: The extended network offers you the freedom to choose from many of the providers who participate with Regence BlueShield. You may use these providers without a referral if you are willing to pay a greater share of the cost. As in the Selections network, a deductible applies and you pay a copay at the time you receive most outpatient services.

Self-Referral Care: You may self-refer to an approved smoking cessation provider, You may also self-refer to an approved chiropractor for covered chiropractic services and receive the Selections network benefit level. A female subscriber or dependent may refer herself for covered women's health care services to a Selections provider including physicians, advanced registered nurse practitioners specializing in women's health and midwifery, physician's assistants, or midwives and receive the Selections network benefit level.

Copays: Each covered person will be required to pay a $15 copay for certain services such as outpatient professional services performed in the office, home, hospital outpatient department or other facility, and a $75 copay for each visit to a hospital emergency room for illness, injury or surgery (waived if directly admitted to the hospital as an inpatient).

Stoploss Limits: The benefits of this plan will be provided at the percentage specified until the annual stoploss amount maximum has been reached for the Selections network. When your eligible out-of-pocket coinsurance expenses for the Selections network have reached $3,000 per person per calendar year, the payment level for most benefits within the Selections network only will increase to 100% of the allowed amount for the remainder of the calendar year. The maximum stoploss amount per family is three times the individual stoploss amount. There is no stoploss maximum on extended network benefits.

Emergency Care: Inside the service area, your plan will cover treatment by a network or non-network physician or hospital. You will receive the higher level of benefits only if you notify us within 24 hours or as soon as is reasonably possible, and you agree to follow our managed care guidelines. Otherwise, you will receive the lower level of benefits. Benefits will be based on the recognized provider's actual charge for the service.

Care Outside the Service Area: You have the same coverage and limitations for care outside our service area as you do within the extended network. However, any benefit payable at 50% will be paid at 80%. Any additional charges will be your responsibility and you may have to submit your own claims. If you live in the service area and are admitted to a hospital while traveling outside the service area, you must contact the Company within 24 hours to receive full plan benefits. You must also agree to comply with the Company's managed care guidelines, which may require you to move under the care of a Selections provider in the service area as soon as feasible. If you meet all requirements, inpatient benefits will be provided at the Selections network level. Preadmission approval is required for all inpatient admissions outside the service area, except emergency services. No benefits will be provided if a Member leaves his or her state of residence for the purpose of obtaining medically necessary care for any condition unless, in the determination of the Company, care cannot be provided in that state. In this case. care must be approved by the Company in writing in advance.

Waiting Periods: No benefits are provided for treatment relating to a transplant until you have been covered under this or a prior plan with the Company or the Company's HMO subsidiary for 12 consecutive months. No benefits will be provided for preexisting conditions until you have been covered under this plan for nine consecutive months, unless you were continuously covered for at least nine months under the immediately preceding plan.

This is a brief summary of benefits; it is not a certificate of coverage. For full coverage provisions, including a description of waiting periods, limitations, and exclusions, refer to the plan contract.