Regence Valiance (PPO)

H1304 - 001 - 0
3.5 out of 5 stars (3.5 / 5)

Regence Valiance (PPO) is a Medicare Advantage (Part C) Plan by Regence BlueShield of Idaho.

This page features plan details for 2024 Regence Valiance (PPO) H1304 – 001 – 0 available in Select Counties in Idaho/Asotin Co, WA.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

Regence Valiance (PPO) is offered in the following locations.

Plan Overview

Regence Valiance (PPO) offers the following coverage and cost-sharing.

Insurer:Regence BlueShield of Idaho
Health Plan Deductible:$0.00
MOOP:$9,550 In and Out-of-network
$5,500 In-network
Drugs Covered:No

Ready to sign up for Regence Valiance (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

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 (PPO) qualifies for a monthly Medicare Give Back Benefit of $45.00.

Premium Reduction:$45.00

Premium Breakdown

Regence Valiance (PPO) 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 $45.00 $129.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Regence Valiance (PPO) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$9,550 In and Out-of-network
$5,500 In-network

Optional supplemental benefits

No

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network Yes, contact plan for further details

Outpatient hospital coverage

In-network $35-300 copay per visit (Authorization is required.) (Referral is not required.)
out-of-network 30% coinsurance per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
out-of-network Primary30% coinsurance per visit (Not applicable.) (Not applicable.)
In-network Specialist$35 copay per visit (Authorization is not required.) (Referral is not required.)
out-of-network Specialist30% coinsurance per visit (Authorization is not required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)
out-of-network 30% coinsurance (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$120 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$30 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic tests and procedures30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Lab services$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Lab services30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$0-300 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic radiology services (e.g., MRI)30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient x-rays$5 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient x-rays30% coinsurance (Authorization is required.) (Referral is not required.)

Hearing

In-network Hearing exam$35 copay (Authorization is not required.) (Referral is not required.)
out-of-network Hearing exam30% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Fitting/evaluation$0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
out-of-network Fitting/evaluation$150 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
In-network Hearing aids$699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Hearing aids$699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

In-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Oral exam50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Cleaning50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Fluoride treatment50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Dental x-ray(s)50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Diagnostic services$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Diagnostic services50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Restorative services50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Restorative services50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Endodontics50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Endodontics50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Periodontics50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Periodontics50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Extractions50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Extractions50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Prosthodontics, other oral/maxillofacial surgery, other services50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Routine eye exam30% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Contact lenses50% coinsurance (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.)
In-network Eyeglass frames$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglass frames50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglass lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglass lenses50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

In-network Occupational therapy visit$10 copay (Authorization is required.) (Referral is not required.)
out-of-network Occupational therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$10 copay (Authorization is required.) (Referral is not required.)
out-of-network Physical therapy and speech and language therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)

Ground ambulance

In-network $275 copay (Not applicable.) (Not applicable.)
out-of-network $275 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$35 copay (Authorization is not required.) (Referral is not required.)
out-of-network Foot exams and treatment30% coinsurance (Authorization is not required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen)50% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Prosthetics (e.g., braces, artificial limbs)50% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay (Authorization is required.) (Not applicable.)
out-of-network Diabetes supplies50% coinsurance per item (Authorization is required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Chemotherapy30% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Other Part B drugs30% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.)
out-of-network Part B Insulin drugs30% coinsurance (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $350 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
out-of-network 30% per day for days 1 and beyond (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$350 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatric30% per day for days 1 through 190 (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$25 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit with a psychiatrist30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$25 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit with a psychiatrist30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit$25 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit$25 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit30% coinsurance (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$203 per day for days 21 through 48
$0 per day for days 49 through 100 (Authorization is required.) (Referral is not required.)
out-of-network 30% per day for days 1 through 100 (Authorization is required.) (Referral is not required.)

Ready to sign up for Regence Valiance (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

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