Regence Valiance (HMO)
H1997 - 008 - 0
(3 / 5)
Regence Valiance (HMO) is a Medicare Advantage (Part C) Plan by Regence BlueShield.
This page features plan details for 2024 Regence Valiance (HMO) H1997 – 008 – 0 available in Select Counties in Washington.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Regence Valiance (HMO) is offered in the following locations.
Plan Overview
Regence Valiance (HMO) offers the following coverage and cost-sharing.
| Insurer: | Regence BlueShield |
| Health Plan Deductible: | $0.00 |
| MOOP: | $5,900 In-network |
| Drugs Covered: | No |
Ready to sign up for Regence Valiance (HMO) ?
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Regence Valiance (HMO) qualifies for a monthly Medicare Give Back Benefit of $25.00.
| Premium Reduction: | $25.00 |
Premium Breakdown
Regence Valiance (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $25.00 | $149.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Regence Valiance (HMO) also provides the following benefits.
| $0 |
| In-network | No |
| $5,900 In-network |
| No |
| In-network | Yes, contact plan for further details |
| $40-275 copay per visit (Authorization is required.) (Referral is not required.) |
| Primary | $0 copay (Not applicable.) (Not applicable.) |
| Specialist | $40 copay per visit (Authorization is not required.) (Referral is required.) |
| $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $120 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $40 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $20 copay (Authorization is required.) (Referral is not required.) |
| Lab services | $0-20 copay (Authorization is required.) (Referral is not required.) |
| Diagnostic radiology services (e.g., MRI) | $0-300 copay (Authorization is required.) (Referral is not required.) |
| Outpatient x-rays | $10 copay (Authorization is required.) (Referral is not required.) |
| Hearing exam | $40 copay (Authorization is not required.) (Referral is not required.) |
| Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| Hearing aids | $699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Restorative services | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Endodontics | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Periodontics | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Extractions | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglasses (frames and lenses) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
| Physical therapy and speech and language therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
| $220 copay (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Foot exams and treatment | $40 copay (Authorization is not required.) (Referral is required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
| $390 per day for days 1 through 4 $0 per day for days 5 through 90 (Authorization is required.) (Referral is required.) |
| Inpatient hospital – psychiatric | $390 per day for days 1 through 4 $0 per day for days 5 through 90 (Authorization is required.) (Referral is not required.) |
| Outpatient group therapy visit with a psychiatrist | $30 copay (Authorization is required.) (Referral is not required.) |
| Outpatient individual therapy visit with a psychiatrist | $30 copay (Authorization is required.) (Referral is not required.) |
| Outpatient group therapy visit | $0-30 copay (Authorization is required.) (Referral is not required.) |
| Outpatient individual therapy visit | $0-30 copay (Authorization is required.) (Referral is not required.) |
| $0 per day for days 1 through 20 $203 per day for days 21 through 50 $0 per day for days 51 through 100 (Authorization is required.) (Referral is not required.) |
Optional Benefits
Package #1
| Comprehensive dental: | Monthly Premium: | $24.00 |
| Comprehensive dental: | Deductible: | N/A |
Ready to sign up for Regence Valiance (HMO) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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