Regence

Regence Cascade Bronze

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $6,000 Family: $12000 Per Person: $6000
Combined Medical and Drug Out of Pocket Maximum	Individual: $9,200 Family: $18400 Per Person: $9200

Office Visit

Primary Doctor	CoPay: $50.00 CoInsurance: Not Applicable Covered: Covered Benefit Explanation: First two in-person visits covered at $1 copay, then regular copay amounts apply. This two-visit alloweance is shared with Other Practitioner Office Visit (Nurse, Physician Assistant).",",
Specialist	Standard: Not Applicable CoPay: Covered

Prescription Drug Information

Preferred Brand Drugs	Standard: Not Applicable; 40.00% Coinsurance after deductible CoPay: Covered CoInsurance: 90 Covered: Days per Month Limit Unit : Coverage is limited to a 90-day supply retail or 90-day supply mail order per fill or refill. Insulin limit: $35 for a 30 day supply and $105 for a 90 day
Non Preferred Brand Drugs	Standard: Not Applicable; 40.00% Coinsurance after deductible CoPay: Covered CoInsurance: 90 Covered: Days per Month Limit Unit : Coverage is limited to a 90-day supply retail or 90-day supply mail order per fill or refill. Insulin limit: $35 for a 30 day supply and $105 for a 90 day
Generic Drugs	Standard: $32.00; Not Applicable CoPay: Covered CoInsurance: 90 Covered: Days per Month Limit Unit : Coverage is limited to a 90-day supply retail or 90-day supply mail order per fill or refill. Insulin limit: $35 for a 30 day supply and $105 for a 90 day
Specialty Drugs	Standard: Not Applicable; 40.00% Coinsurance after deductible CoPay: Covered CoInsurance: 30 Covered: Days per Month Limit Unit : First fill allowed at a retail pharmacy. Additional fills must be provided at a specialty pharmacy. Coverage is limited to a 30-day supply for specialty and self-administrable cancer chemotherapy medications from a specialty pharmacy per fill or refill. Insulin limit of $35 for a 30 day supply and $105 for a 90 day supply Benefit Explanation: Not Applicable

Inpatient Coverage

Hospital Services	Standard: 40.00% Coinsurance after deductible CoPay: Covered
Inpatient Services	Standard: Not Applicable; 40.00% Coinsurance after deductible CoPay: Covered

Emergency and Urgent Care

Emergency Room	Standard: Not Applicable; 40.00% Coinsurance after deductible CoPay: Covered Limit Unit : Out of service area coverage is available. Exclusions: $100.00 Benefit Explanation: Not Applicable
Urgent Care Facility	CoPay: Covered Limit Unit : Out of service area coverage is available. Exclusions: Not Applicable Benefit Explanation: 40.00% Coinsurance after deductible

Maternity

Labor and Delivery Hospital Stay	CoPay: Covered Exclusions: No Charge Benefit Explanation: No Charge
Pre and Postnatal Office Visit	CoPay: Covered Exclusions: No Charge Benefit Explanation: No Charge

Vision

Routine Eye Exams for Children

CoPay: Covered
CoInsurance: 1
Covered: Exam(s) per Year

Major Dental Care

Routine Dental Checkups for Children	CoPay: Not Covered
Routine Dental Checkups for Adults	CoPay: Not Covered
Basic Dental Care - Adult	CoPay: Not Covered
Basic Dental Care - Child	CoPay: Not Covered
Major Dental Care - Adult	CoPay: Not Covered
Major Dental Care - Child	CoPay: Not Covered Exclusions: https://www.regence.com/go/2025/WW/health-coverage-for-individuals-and-families Benefit Explanation: https://regence.com/go/2025/SBC/WW/CascadeBronzeIFNEx.pdf