Regence Cascade Gold Individual and Family Network – EPO
Network type: EPO
Coverage tier: Gold
Primary care visit: $15 copay
Specialist visit: $40 copay
Urgent care visit: $35 copay
Description
Health Care Plan Details
Network type | EPO |
Deductible | $600 per person $600 per person |
Out-of-pocket max | $6,100 per person $12,200 per family |
Metal tier | Gold |
Visit Copay
Primary care visit | $15 copay |
Specialist visit | $40 copay |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | $35 copay |
Emergency room | $450 copay after deductible |
Ambulance | $375 copay |
Hospital stay (facility) | first 5 day(s) $525 per day then $0 copay |
Hospital stay (physician) | $525 copay |
Outpatient procedure (facility) | $350 copay after deductible |
Outpatient procedure (physician) | $75 copay after deductible |
Physical rehabilitation | $25 copay |
Maternitowny and Pregnancy
Labor, delivery, hospital stay | first 5 day(s) $525 per day then $0 copay |
Pharmacy, Drugs, and Medication
Generic | $10 copay |
Brand | $60 copay |
Non-preferred Brand | $100 copay |
Specialty | $100 copay |
Lab Tests and Diagnostic Procedures
X-rays | $30 copay |
Imaging (CT/PET/MRI) | $300 copay after deductible |
Blood work | $20 copay |
Mental and Psychiatric Health Care
Mental Health outpatient services | $15 copay |
Psychiatric hospital stay | first 5 day(s) $525 per day then $0 copay |