Dual Option Matrices

Eff. 07/01/10 through 12/31/11:

• Community Dual Option Matrix
• Community HSA Dual Option Matrix

Eff. 01/01/12 and beyond:

• Innova Dual Option Matrix (Groups 25-50) (PDF)
• Innova/ HSA 2.0 Dual Option Matrix (Groups 10-50) (PDF)

Benefit Options

Eff. 10/15/2009 and Beyond

• Benefit Options for Traditional, Selections & Preferred Plans (except FourFront, HSA-Qualified Preferred Plan 80/80/60 and Regence HSA Healthplan)
• Benefit Options for Preferred Plan FourFront
• Benefit Options for Regence HSA Healthplan

Exclusions and Limitations—effective 1/1/2010 and beyond

Eff. 10/15/2009 and Beyond

51+ Employees

• Preferred Plan FourFront - $15 Copay
• Preferred Plan FourFront - $25 Copay

2-50 Employees

• Preferred Plan FourFront - $15 Copay
• Preferred Plan FourFront - $25 Copay

Eff. 1/1/2010 and Beyond

100+ Employees

• Preferred Plan FourFront - $15 Copay
• Preferred Plan FourFront - $25 Copay

Eff. 10/15/2009 and Beyond

51+ Employees

• Regence HSA Healthplan
• Preferred Plan 80/80/50
• Preferred Plan 100/90/60/15
• Preferred Plan 100/90/60/15 with Deductible Waiver
• Preferred Plan 100/90/60/20
• Preferred Plan 100/90/60/20 with Deductible Waiver
• Preferred Plan 100/90/60/25
• Preferred Plan 100/90/60/25 with Deductible Waiver

2-50 Employees

• Regence HSA Healthplan
• Preferred Plan 80/80/50
• Preferred Plan 100/90/60/15
• Preferred Plan 100/90/60/15 with Deductible Waiver
• Preferred Plan 100/90/60/20
• Preferred Plan 100/90/60/20 with Deductible Waiver
• Preferred Plan 100/90/60/25
• Preferred Plan 100/90/60/25 with Deductible Waiver

Eff. 1/1/2010 and Beyond

100+ Employees

• Regence HSA Healthplan
• Preferred Plan 80/80/50
• Preferred Plan 100/90/60/15
• Preferred Plan 100/90/60/15 with Deductible Waiver
• Preferred Plan 100/90/60/20
• Preferred Plan 100/90/60/20 with Deductible Waiver
• Preferred Plan 100/90/60/25
• Preferred Plan 100/90/60/25 with Deductible Waiver

Eff. 10/15/2009 and Beyond

51+ Employees

• Selections 80/50/15
• Selections 80/50/20
• Selections 100/70/15
• Selections 100/70/20

2-50 Employees

• Selections 80/50/15
• Selections 80/50/20
• Selections 100/70/15
• Selections 100/70/20

Eff. 1/1/2010 and Beyond

100+ Employees

• Selections 80/50/15
• Selections 80/50/20
• Selections 100/70/15
• Selections 100/70/20

Eff. 10/15/2009 and Beyond

51+ Employees

• Traditional 50% Plan

2-50 Employees

• Traditional 50% Plan

Eff. 1/1/2009 and Beyond

100+ Employees

• Traditional 50% Plan

• Preferred Medication List (PML)/Formulary (located on the RegenceRx site)

• Rx Medications $15 Closed Formulary
• Rx Medications $20 Closed Formulary
• Rx Medications $7/30%/50%
• Rx Medications $12/30%/50%
• Rx Medications $10/$20/$40
• Rx Medications $500 Deductible
• Rx Medications 50%

Product Information & Summary
 

• Columbia Dental Plan CD-6
• Columbia Dental Plan CD-10
• Columbia Dental Plan CD-15A
• Columbia Dental Plan CD-15B
• Orthodontic Option Columbia Dental Plan

• Traditional Dental Plan 10
• Traditional Dental Plan 11
• Traditional Dental Plan 12
• Traditional Dental Plan 13
• Traditional Dental Plan 14
• Traditional Dental Plan 15
• Traditional Dental Plan 17
• Traditional Dental Plan 18
• Orthodontic Option Traditional Plan