Dual Option Matrices

• Community Dual Option Matrix
• Community HSA Dual Option Matrix

Benefit Options

• 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
 

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

• Regence HSA Healthplan (Groups 2+)
• 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

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

• 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

Vision coverage is in the Optional Benefits section of each product page:

• Activate
• Innova
• Engage

• Vision Care Option #7
• Vision Care Option #11 (Except HSA-Qualified Preferred Plan 80/80/60)

• Vision Care Option #7
• Vision Care Option #11

• Vision Care Option #9
• Vision Care Option #10