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Product Portfolio

Washington Large Group Plans

Large Group Plans

Product Type

Annual Deductible

Benefit
(personal physician-provider copayment/other provider coinsurance/out-of-pocket maximum)

Providence Personal Option
Personal OptionNAPE 10/10/1200
Personal Option w/ Deductible$250PE 10/10/1700 + 250D
$250PE 15/20/2000 + 250D
$500PE 15/20/2000 + 500D
$500PE 20/20/2000 + 500D
$750PE 20/20/2500 + 750D
$1000PE 15/30/2500 + 1000D
$1000PE 25/30/3000 + 1000D
$1500PE 15/30/2000 + 1500D
$2000PE 25/30/3000 + 2000D
$3000PE 25/20/3000 + 3000D
$5000PE 20/20/4000 + 5000D

Providence Open Option
Open OptionNAOP 10/10/30/1200
NAOP 50/50/3000
Open Option w/ Out-of-Plan Deductible$250OP 15/20/40/2000 + 250D
Open Option w/ Common Deductible$250OP 10/10/20/1700 + 250CD
$250OP 15/20/40/1700 + 250CD
$250OP 20/30/40/2000 + 250CD
$500OP 15/20/40/2000 + 500CD
$500OP 25/20/30/2000 + 500CD
$750OP 20/10/30/2000 + 500CD
$750OP 20/20/40/2500 + 750CD
$1000OP 15/20/30/2000 + 1000CD
$1000OP 15/30/50/2500 + 1000CD
$1000OP 25/20/30/2500 + 1000CD
$1500OP 15/30/50/2500 + 1500CD
$1500OP 25/20/30/2500 + 1500CD
$2000OP 20/20/30/3000 + 2000CD
$3000OP 25/20/40/3000 + 3000CD
$5000OP 20/20/40/4000 + 5000CD
Value Based Open Option w/ Common Deductible$250VBOP 10/20/30/40/3000 + 250CD
$500VBOP 10/20/30/40/3000 + 500CD
$750VBOP 10/20/30/40/3000 + 750CD
$1000VBOP 10/20/30/40/3000 + 1000CD
$2000VBOP 10/20/30/40/3000 + 2000CD
HSA Qualified$1200HSA OP 20/20/40/3000 1500CD
$1500HSA OP 20/20/40/4000 2000CD
$2600HSA OP 20/20/40/5000 2600CD

Providence Traditional Option
Traditional Option$250TO 20/1000 250D
$250TO 20/2500 250D
$500TO 20/5000 500D

Other
Out-of-AreaNAOOA 20/1000

 

Large Group Riders

Product Type

Benefit
VisionVision 200
Vision 300
Open Option and Personal Option RxRx 10/20
Rx 10/30
Rx 10/40
Rx 15/30
Rx 15/45
Rx 15/50
Rx 10/50/1000
Rx 5/10/30/50/2000
Rx 5/10/50/50/2000
Rx 5/15/30/50/2000
Rx 5/15/40/50/2000
RXtra plans (2-copay per 90 day mail order)Rxtra 10/20
Rxtra 10/30
Rxtra 15/30
Rxtra 15/45
Rxtra 15/50
Rxtra 10/50/1000
Early RetireeRETIREE
Voluntary SterilizationSTERILSUM
Domestic PartnerDOMESTIC PARTNER

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