Compare medical plans
Information and tools to help you choose the medical plan that's right for you.
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Choosing a medical plan is an important decision. Many people think first about cost and which doctors and hospitals are in the network. All medical plans cover the same basic health care services, but vary in other ways such as provider networks, premiums, your out-of-pocket costs, and prescription drug coverage.
As you research your plan options, consider these questions:
What are my costs for care?
Get a side-by-side comparison of common medical benefits and costs for services.
Are my providers in the plan's network?
Use the health plans' provider directories to find a provider near you and make sure the provider is in your plan's network. See Find a provider.
Do I live in the plan's service area?
In most cases, you must live in a medical plan’s service area to join the plan. See Medical plans available by county.
What are the monthly plan costs?
Higher plan costs don’t necessarily mean higher quality of care or better benefits. Each plan has the same basic level of benefits. Generally, the classic plans have higher monthly costs than the value plans. However, classic plans may have lower annual deductible, copays, or coinsurance costs. See Plan costs.
What kind of coverage does the plan offer?
Look at the plans' benefits booklets and Summaries of Benefits and Coverage to find out what is covered and your costs for care. See Benefits and coverage by plan.
Will I receive coordinated care?
If you are seeing more than one health provider or have complicated medical issues, check with your providers to see how they share information about your health so you don't have to fill out duplicate forms or get unnecessary care.
Does the plan offer online or after-hours resources?
Check to see if the plan provides access to a 24/7 nurse line or a medical help line for after-hours support or to help you decide whether you need to see a provider. Most plans offer online resources to help you easily find information about your care to support you in making the decisions that work best for you.
The PEBB Program offers three types of medical plans:
Managed care plans may require you to select a primary care provider (PCP) within its network to fulfill or coordinate all of your health needs. The plan may not pay benefits if you see a non-contracted provider.
Preferred provider organization health plans
PPO’s allow you to self-refer to any approved provider type in most cases, but usually provide a higher level of coverage if the provider contracts with the plan.
Consumer-directed health plans (CDHPs)
CDHPs let you use a health savings account (HSA) to help pay for out-of-pocket medical expenses tax free, have a lower monthly premium than most other plans, and a higher deductible and a higher out-of-pocket limit. See Health plans with health savings accounts (HSAs).
In general, you may choose from the plans listed below. Your options are limited to the plans available in your county. Remember, if you cover eligible dependents, everyone must enroll in the same medical plan.
- Group Health Classic
- Group Health Value
- Group Health SoundChoice
- Kaiser Permanente Classic
Consumer-directed health plans (CDHPs)
- Group Health CDHP
- Kaiser Permanente CDHP
- UMP CDHP, administered by Regence BlueShield
- UMP Classic, administered by Regence BlueShield
- UMP Plus, administered by Regence BlueShield
All medical plans require you to pay an annual deductible before the plan pays for covered services. UMP Classic also has a separate annual deductible for some prescription drugs. Preventive care and certain other services are exempt from the medical plans’ deductibles. This means you do not have to pay your deductible before the plan pays for the service.
Some plans require you to pay a fixed amount, called a copay. Other plans require you to pay a percentage of an allowed fee (called a coinsurance) when you receive care.
The annual out-of-pocket limit is the most you pay in a calendar year for covered benefits. UMP Classic has a separate out-of-pocket limit for prescription drugs. Once you have paid this amount, the plans pay 100 percent of allowed charges for most covered benefits for the rest of the calendar year. Certain charges incurred during the year (such as your annual deductible, copays, and coinsurance) count toward your out-of-pocket limit. There are a few costs that do not apply toward your out-of-pocket limit:
- Monthly premiums and applicable surcharges.
- Charges above what the plan pays for a benefit.
- Charges above the plan’s allowed amount paid to a provider.
- Charges for services or treatments the plan doesn’t cover.
- Coinsurance for non-network providers.
- Prescription-drug deductible and prescription-drug coinsurance (UMP Classic only).
Some plans allow you to self-refer to any network provider; others require you to have a referral from your primary care provider. All plans allow self-referral to a participating provider for women’s health-care services.
In general, PEBB plans don’t require you to file claims. However, UMP Classic members may need to file a claim if they receive services from a non-network provider. CDHP members should also keep paperwork received from their provider or for qualified health care expenses to verify eligible payments or reimbursements from their health savings account.
Coordination with your other benefits
If you are also covered through your spouse’s or state-registered domestic partner’s comprehensive group health coverage, call the plan directly to ask how they will coordinate benefits. All PEBB plans coordinate benefit payments with other group plans, Medicaid, and Medicare. This coordination ensures benefit costs are more fairly distributed when a person is covered by more than one plan. However, the amount your PEBB plan pays for benefits will not change for a particular service or treatment, even if you or a dependent have an individual medical policy covering that service or treatment.