Seattle University's Medical Plan Options

The Regence Blue Shield Preferred Plan allows you the choice of using Preferred providers (PPO) or Participating Providers (PAR). Services performed by Participating providers are usually covered at a lower level than if you use a Preferred provider. This plan has a calendar year deductible that must be satisfied before many services are covered.

Out-of-network providers are not covered under the Regence Blue Shield Plan.

The Group Health Plan is a Health Maintenance Organization (HMO) plan. This plan has no deductible and requires a copayment for many services. To receive coverage, you must use a Group Health provider or services will not be covered. (Exceptions may be granted in certain emergency situations.)

The following comparison chart shows the differences in coverage between the two medical plan options.

Plan Year 2007	Regence Blue Shield Preferred Plan		Group Health Cooperative HMO Plan
Choice of Provider or Facility	Any Preferred (PPO) or Participating (PAR) provider or facility		Any Group Health family practice physician or Group Health designated facility
Calendar Year Deductible	$350 per person $700 family maximum		None
Calendar Year Out-of-Pocket Maximum	$2,500 per person $5,000 limit per family		$2,000 per person $4,000 limit per family
Inpatient Hospital Benefits	Preferred (PPO): 90% after deductible	Participating (PAR): 60% after deductible	100%
Surgical Benefits Inpatient	Preferred (PPO): 90% after deductible	Participating (PAR): 60% after deductible	100%
Surgical Benefits Outpatient	Preferred (PPO): 90% after deductible	Participating (PAR): 60% after deductible	$15 copay then 100%
Physician Services Office Visits	$15 copay then 100% (deductible waived)	$15 copay then 60% (deductible waived)	$15 copay then 100%
Physician Services Inpatient	100% after deductible	60% after deductible	100%
Prescription Drugs Retail Pharmacy (up to a one month supply)	At Participating Pharmacy Generic - $10 copay Formulary Brand Name - $20 copay Non-Formulary Brand Name - $50 copay		At Group Health Pharmacy Generic - $10 copay Formulary Brand Name - $20 copay
Prescription Drugs Mail-Order (up to a 90 day supply)	Two times pharmacy copay		Two times pharmacy copay
Preventive Care Includes wellness exams, routine physicals, immunizations, ob/gyn visits and cancer screenings	Covered as any other condition (deductible waived) limited to $500 per calendar year		$15 copay per visit according to GHC's well child & well adult schedules
Spinal Manipulation	$15 copay then: Preferred (PPO): 100% after deductible limited to 10 visits per calendar year	$15 copay then: Participating (PAR): 60% after deductible limited to 10 visits per calendar year	$15 copay then 100% limited to 10 visits per calendar year
Diagnostic Lab & X-ray	Preferred (PPO): 100% after deductible	Participating (PAR): 60% after deductible	100%
Maternity Care	Covered as any other condition		Covered as any other condition
Emergency Room	$75 copay then: Preferred (PPO): 90% after deductible copay waived if admitted	$75 copay then: Participating (PAR): 60% after deductible copay waived if admitted	GHC facility - $75 copay, waived if admitted Non-GHC facility - $125 copay* *must contact GHC within 24 hours
Mental and Nervous Disorders Inpatient	Preferred (PPO): 90% after deductible limited to 12 days per calendar year	Participating (PAR): 60% after deductible limited to 12 days per calendar year	80% - GHC MUST pre-authorize limited to 12 days per calendar year
Mental and Nervous Disorders Outpatient	Preferred (PPO): 100% after deductible limited to 20 days per calendar year	Participating (PAR): 50% after deductible limited to 20 visits per calendar year	$15 copay per individual/ family/ couple visit, $10 copay per group visit. limited to 20 visits per calendar year
Chemical Dependency	Preferred (PPO): 100% after deductible limited to $13,500 every 24 months	Participating (PAR): 60% after deductible limited to $13,500 every 24 months	Covered as any other condition limited to $13,500 every 24 months
Lifetime Maximum	$2,000,000		$2,000,000

For a printable version of the Medical Plan Comparison table shown above, click here.