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Platinum
Gold
Silver
Silver
Bronze
Bronze (HSA)
Plan Name Platinum High MODA - Be Serene MODA - Be Agile MODA - Be Reliable Premera - Preferred Bronze Premera - Preferred Bronze "HSA"
Network Regence First Choice Health First Choice Health First Choice Health Premera Signature Premera Signature
Type PPO PPO PPO PPO PPO PPO
Copay Unlimited office visits, $20 copay PCP, specialists $30 copay $15 $20 $25/visit for first 4 visits, 25% subsequent visits Unlimited office visits, $15 copay PCP, specialists $45 copay 20%
Deductible per Person $250 $650 $1,250 $2,750 $5,500 $5,250 per individual, x2 if family
Coinsurance 90% 85% / 15% 70% / 30% 75% / 25% 80% N/A
Maximum Out of Pocket (includes deductible) $2,500 $4,000 $6,350 $6,600 $6,350 $5,250, x2 if family
Value N/A $2 $2 $2 N/A N/A
Generic $5 50% 50% 50% $25 copay After deductible 100% covered
Brand Category 1: $20, Category 2: 50%, Specialty: 40% 50% 50% 50% Deductible then 50% covered After deductible 100% covered
Additional Info Plan with the lowest Out of Pocket Max. Great for expecting mothers or anyone with a high-likelihood of meeting their deductible during the year. A great option with greatest benefits at the core of the plan. A plan with high benefits at a greater value without a limit on office visits with copay only. A plan with high benefits at a greater value with limited office visits with copay only. A great option with value at the core of the plan. A great value for those who don't need the benefits of the higher plans. HSA plans require the deductible be met prior to benefits being paid.
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