This summary of the LifeWise & Premera health insurance plans gets extremely detailed. If you have picked one of these plans please read all the way through. Then BOOKMARK this page so you can come back when you have questions on how medical issues are covered. For more details call 425-802-2783. Yes it is that easy.
When comparing Premera & LifeWise plans and they look alike you are not going crazy. They are the same company, same plans, same deductibles, same coverages, so going forward I will reference both companies as Premera. One key difference is the Premera MSP plan offered only through the Health Exchange does NOT cover abortion services and is 40¢ cheaper per month.
The other difference is how you look up doctors (yet the same network of doctors).
NETWORK OF DOCTORS
PREMERA www.premera.com. The network you are in is the “Heritage Signature” & “BlueCard PPO” network once you click the “find a doctor” button. This is NOT the same Premera network as the Microsoft or Group Plans…it is slightly more narrow.
LIFEWISE www.lifewisewa.com. The network you are in is the “LifeWise Connect” network once you click the “find a doctor” button.
In 2014 the main hospitals NOT covered are Swedish, UW Medical, Harborview, and Childrens Medical Centers on this plan.
In 2015 they will be covering Swedish, Childrens, UW Medical and Harborview. If your doctor takes Premera, it does NOT mean they take your Premera “Heritage Signature” Network plan…call us for a detailed explanation.
COVERAGE DETAILS
DEDUCTIBLE: The Gold Plans have a $1,000 or $1500 deductible. The Silver Plans have a $2,000 or $3,000 deductible. Do NOT over think these plans. They are virtually the same except for the up front deductible for major medical expenses.
The Bronze $5,500 and $6,350 plans are the cheapest catastrophic plans you will find for any company. They do NOT cover as much up front like the Gold & Silver plans. The Health Savings Accounts (HSA’s) provide tax savings, yet the downside is you pay for all medical expenses before the deductible.
PREVENTATIVE EXAMS: ALL plans cover a FREE Preventative visit per year. The catch is that if you talk about anything beyond “preventative” medical issues or they will charge you extra. My doctor charged me an extra $47 last year…
COPAYS: Doctor Visits with Premera plans are very simple, such as the Silver Plan with $15/visit or $45/visit with NO limit on number of visits. Its either the Primary Care Physician (PCP) or a Non-PCP (specialist). You can only have one PCP at a time. If you have multiple “regular” PCP type doctors simply go online www.premera.com and switch your doctor online before your visit…just make sure to switch them back and forth before you see each different PCP.
PRESCRIPTIONS: If you use a lot of expensive Rx, then this is the best plan for you! For GOLD Plans you will pay $10 for Generics and $40 for Brand Name Drugs (there are some exceptions). For SILVER Plans you will pay $15 for Generics and $50 for Brand Name Drugs.
DIAGNOSTIC TESTS: For those that need a lot of bloodwork, x-rays, and diagnostic work these plans pay 80% up front (before the Deductible…truly amazing plan). If you need an MRI, CT or PET scan you will need to pay the Deductible first.
MENTAL HEALTH SPECIALISTS: This is the BEST plan hands down for those that see Psychologists, Psychiatrists, Councilors, or any other type of mental health provider! Your co-pay charge will depend on how your doctor bills it. GOLD Plans will be either $30/visit or 20% of the doctor bill ($200 visit X 20% = $40/visit). SILVER Plans will be $45/visit or 20% of the doctor bill.
CHIROPRACTOR: For ANY Premera plan, you get 10 visits per year at the PCP rate.
ACUPUNCTURE: For ANY Premera plan, you get 12 visits per year at the PCP rate.
MASSAGE & PHYSICAL THERAPY: There are 25 combined visits AFTER the Deductible…as long as they are “medically necessary”. No you can’t get a massage every two weeks because of stress (unless your doctor prescribes it).
This is a brief overview and tried to lay it out easily. Call if you have any questions before choosing a plan or have questions.
Below are my areas of expertise:
- Health Insurance (Every company in Washington State)
- Life Insurance (33 companies)
- Disability Insurance (8 companies)
- Tax Sheltered Accounts (Following IRS guidelines)
Gary Franke, MBA
Independent Broker
Achieve Alpha Insurance, LLC
12507 Bel-Red Rd, Ste 103
Bellevue, WA 98005
(425) 802-2783
gary@achieve-alpha.com
www.achieve-alpha.com