| Providence ExpressCare Virtual visits |
Covered in full |
| Providence ExpressCare Retail Health Clinic visits |
Covered in full |
Plan Details
Columbia 8700 Bronze
Overview
|
Annual Deductible |
$8,700/$17,400 |
|
Out-of-Pocket Maximum |
$8,700/$17,400 |
Choice Network
Important note about these benefits
Below you will find the amount you will pay for in-network services after you have met your calendar year deductible.
When you see a (), the deductible does not apply.
Benefit Summary
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On-Demand Visits
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Preventive Care
Periodic health exams and well-baby care Covered in full
Routine immunizations and shots Covered in full
Colonoscopy (preventive, age 45+) Covered in full
Gynecological exams (1 per calendar year), breast exams and Pap tests Covered in full
Mammograms Covered in full
Nutritional Counseling Covered in full
Tobacco cessation, counseling/classes and deterrent medications Covered in full
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Physician/Professional Services
Office visits to a Primary Care Provider (In-Person or Virtually) $70
Office visits to an Alternative Care Provider (In-Person or Virtually) (such as naturopath)
(Chiropractic manipulation and acupuncture services are covered separately from the office visit at the levels listed for those benefits.)$70
Office visits to specialists (In-Person or Virtually) $100
Inpatient Hospital visits Covered in full
Allergy shots and allergy serums, injectable and infused medications Covered in full
Surgery and anesthesia in an office or facility Covered in full
-
Diagnostic Services
X-ray, lab and testing Services (includes ultrasound) Covered in full
High-tech imaging Services (such as PET, CT or MRI) Covered in full
Sleep studies Covered in full
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Emergency Care and Urgent Care Services
Emergency Services
(For Emergency Medical Conditions only. If admitted to the Hospital, all Services subject to inpatient benefits.)
In-Network
Out-of-NetworkCovered in full
Covered in full
Emergency medical transportation (air and/or ground)
(Emergency transportation is covered regardless of whether or not the provider is an In-Network Provider.)
In-Network
Out-of-NetworkCovered in full
Covered in full
Urgent Care visits (for non-life threatening illness/minor injury)
In-Network
Out-of-Network$100
Covered in full
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Hospital Services
Inpatient/Observation care Covered in full
Skilled Nursing Facility (limited to 60 days per calendar year) Covered in full
Inpatient rehabilitative care
(Limited to 30 days per calendar year. Limits do not apply to Mental Health Services.)Covered in full
Inpatient habilitative care
(Limited to 30 days per calendar year. Limits do not apply to Mental Health Services.)Covered in full
-
Temporomandibular joint (TMJ) services
Temporomandibular joint (TMJ) services
(Limited to $1,000 per calendar year, up to $5,000 per lifetime)50%
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Outpatient Services
Outpatient surgery at an Ambulatory Surgery Center Covered in full
Outpatient surgery at a Hospital-based facility Covered in full
Colonoscopy (non-preventive) at an Ambulatory Surgery Center Covered in full
Colonoscopy (non-preventive) at a Hospital-based facility Covered in full
Outpatient dialysis, infusion, chemotherapy and radiation therapy Covered in full
Cardiac Rehabilitation (post-surgery) First 16 visits Covered in full then Covered in full after deductible
Outpatient rehabilitative services: physical, occupational or speech therapy
(Limited to 30 visits per calendar year. Limits do not apply to Mental Health Services.)Covered in full
Outpatient habilitative services: physical, occupational or speech therapy
(Limited to 30 visits per calendar year. Limits do not apply to Mental Health Services.)Covered in full
Neurodevelopmental therapy Covered in full
Vision Therapy (convergence insufficiency)
(Limited to 12 visits per lifetime)Covered in full
-
Maternity Services
Prenatal visits Covered in full
Delivery and postnatal physician/provider visits Covered in full
Inpatient Hospital/facility services Covered in full
Routine newborn nursery care Covered in full
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Medical Equipment, Supplies and Devices
Medical equipment, appliances, prosthetics/orthotics and supplies Covered in full
Diabetes supplies (such as lancets, test strips, needles, and glucose monitors) 50%
Removable custom shoe orthotics
(Limited to $200 per calendar year)50%
-
Mental Health and Substance Use Disorder
Inpatient and residential services Covered in full
Day treatment, intensive outpatient, and partial hospitalization services Covered in full
Outpatient provider visits (In-Person or Virtually) $70
Applied Behavior Analysis Covered in full
-
Home Health and Hospice
Home health care
(Limited to 130 days per calendar year)
Covered in full
Hospice care Covered in full
Respite care (limited to Members receiving Hospice care; limited to 14 days per lifetime) Covered in full
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Biofeedback
Biofeedback for specified diagnosis (limited to 10 visits per lifetime) Covered in full
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Chiropractic Manipulation, Acupuncture, and Massage Therapy
Chiropractic manipulations (limited to 10 visits per calendar year) $25
Acupuncture (limited to 12 visits per calendar year) $25
Massage Therapy (Copayments and Coinsurance do not apply to your Out-of-Pocket Maximums) (limited to 10 visits per calendar year) $25
Prescription Drugs
-
Up to a 30-Day Supply
Up to a 30-day supply from a participating retail, preferred or specialty pharmacy Tier 1 Covered in full
Tier 2 $35
Tier 3 Covered in full
Tier 4 Covered in full
Tier 5 Covered in full
Tier 6 Covered in full
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90-Day Supply: Preferred Retail
90-day supply from a participating preferred retail pharmacy Tier 1 Covered in full
Tier 2 $105
Tier 3 Covered in full
Tier 4 Covered in full
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90-Day Supply: Mail Order
90-day supply from a participating mail order pharmacy Tier 1 Covered in full
Tier 2 $70
Tier 3 Covered in full
Tier 4 Covered in full
Routine Vision Services
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Pediatric Vision Services (under age 19)
Routine eye exam (limited to 1 exam per calendar year) Covered in full
Lenses (polycarbonate, plastic or glass; limited to 1 pair per calendar year)
Single vision
Lined bifocal
Lined trifocal
Lenticular lensesCovered in full
Frames (limited to 1 pair per calendar year; select from VSP’s Otis & Piper ™ Eyewear Collection)
Covered in full
Contact lens services and materials in place of glasses Covered in full
Low Vision Services Covered in full
We want you to get the most for your money. Whether your goals include better health and fitness or you just need a little extra assistance, our health plans include great perks and care options to make achieving your True Health that much easier.
Member Perks
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Health Coaching
We can help you work towards a healthier you.
It's time to team up. Whether you'd like to increase your activity level, reduce stress, improve your eating habits, lose weight, quit tobacco or just feel better every day, a Providence health coach can help. We’re here to remove barriers, support your efforts, motivate you when you need a nudge and be a resource on your journey to a healthier, happier you.
Learn more -
Behavioral Health Resources
We're here for you when you need us.
Meet with a licensed mental health provider that best suits your needs, fully confidential – always.
Learn more -
ChooseHealthy®
Save big while you achieve your health goals.
We want to give you every opportunity we can to help you achieve your True Health. Save big on wellness products and memberships that will help you thrive on your road to better health.
Learn more -
Active&Fit Direct™
Big discounts on your fitness membership.
Whether you’re ready to kick-start your routine — or just looking to level up — the Active&Fit Direct™ program allows you to choose from more than 16,000 participating fitness centers and YMCAs nationwide for $25 a month (plus a $25 enrollment fee and applicable taxes; 2-month commitment required).
Learn more -
ID Protection
Enjoy the peace of mind you deserve.
We’ve partnered with Assist America Identity Theft Protection® to give you 24/7 access to identity theft protection experts, fraud monitoring and warning notifications, resolution services, and lost or stolen card assistance.
Learn more -
Travel Assistance
Accidents happen. We've got you covered.
We’ve partnered with Assist America Travel Assistance® to provide you with the logistical support for your emergency medical needs when you’re traveling internationally or at least 100 miles or more from your home.
Learn more -
LifeBalance
Health and well-being go hand in hand.
That’s why we’ve partnered with LifeBalance to give you and your family access to discounts on more than 20,000 recreational, cultural, and travel related businesses and activities.
Learn more
Member Care Options
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ProvRN – Free
Access to care 24/7.
Health issues don’t fit neatly into a 9 to 5 schedule — and neither should your access to health information. Providence Health Plan members can call ProvRN around the clock to ask questions about their health.
Learn more -
ExpressCare Clinics – Free*
Same day in-person treatment.
When you need to see someone and your regular care provider is not available. With many convenient locations, it’s easy to find a clinic near you.
Learn more
*Washington health plans may have a copay when utilizing ExpressCare Clinics. Washington health plans have a copay when utilizing ExpressCare Clinics.
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ExpressCare Virtual – Miễn phí*
Nhận được dịch vụ chăm sóc mà quý vị muốn, vào lúc mà quý vị cần.
Trao đổi với nhà cung cấp từ bất cứ đâu bằng máy tính bảng, điện thoại thông minh hoặc máy tính. Đây là lựa chọn tuyệt vời cho các đơn thuốc và phương pháp điều trị không yêu cầu chăm sóc trực tiếp. Được cung cấp trên toàn quốc.
Tìm hiểu thêm
Thăm khám qua ExpressCare Virtual miễn phí cho hầu hết các chương trình bảo hiểm y tế của Providence. Các thành viên HSA trước tiên phải đạt đến mức khấu trừ của chương trình, nhưng chi phí thăm khám ExpressCare thấp hơn đáng kể so với thăm khám tại phòng khám. Các dịch vụ phụ trợ, chẳng hạn như xét nghiệm sinh hóa, có thể phải chịu chia sẻ chi phí bổ sung.
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Primary Care – $
Your primary healthcare partner.
Primary care providers develop a relationship with you and know your health history. Visit them for check-ups, managing chronic conditions, and specialist referrals.
Learn more -
Urgent Care – $$
When you need help right away.
Urgent care is where you turn when you know you need help and can’t wait for an appointment. This is best for minor injuries, cuts, burns, pains, and sprains.
Learn more -
Emergency Care – $$$
When you think you may be in danger.
Use emergency care for symptoms like suspected heart attack, stroke, severe abdominal pain, poisoning, choking, loss of consciousness, and uncontrolled bleeding.
Learn more
If you ever think your life or well-being could be in serious danger, call 911 immediately.