Your Medical Benefits
Benefits
Download the Essential Worker Healthcare Trust Benefits Guide
Eligibility
Find out if you’re eligible for coverage through the Trust.
Affordable, quality care for you and your family
Benefit Summary
The Essential Worker Healthcare Trust’s plan is designed with the help of long-term care workers. These new healthcare plan options have been designed to provide the care you and your family need with:
- Lower monthly premium payment for employee and dependent coverage
- Free preventive care, like regular checkups
- Free generic drugs
- Lower deductibles and other out-of-pocket costs
Most workers can choose between two healthcare plans
Many long-term care workers will have a choice of two programs: an HMO through Kaiser Permanente and traditional coverage using the Regence PPO network. If you choose Kaiser Permanente, you must use Kaiser Permanente healthcare providers for your services to be covered.
If you live outside the Kaiser Permanente service area, or choose not to enroll in Kaiser Permanente, you can enroll in coverage through the Regence PPO. For your services to be fully covered at the maximum benefit level with the Regence PPO, you must use healthcare providers in the Regence network.
Plans at a Glance
Both plans cover the same kinds of services, with the same costs to you when you need care—but how they work is different.
You can view our Terms to Know to learn more about the language used to describe these plans.
| Regence PPO In-network providers* | Kaiser Permanente HMO In-network providers* | |
| Annual deductible | $800 individual/$1,600 family | $800 individual/$1,600 family |
| Annual max out-of-pocket | $2,000 individual/$4,000 family | $2,000 individual/$4,000 family |
| Preventive care | You pay $0 | You pay $0 |
| Primary care office visit | You pay $20 per visit | You pay $5 for the first three visits, $20 after |
| Specialist, physical therapy, chiropractic copay | You pay $40 per visit | You pay $40 per visit |
| Urgent care | You pay $60 per visit | You pay $60 per visit |
| Emergency room | You pay $160 (waived if admitted to the hospital) then 20%, after you meet the deductible | You pay 20% after you meet the deductible |
| Most other services (such as labs and x-rays, surgery, hospital stays, etc.) | You pay 20% after you meet the deductible | You pay 20% after you meet the deductible |
* For more details on the plans, visit More Plan Information to view both Regence and Kaiser’s Summary of Benefits and Coverage (SBC). Regence’s SBC will show you your costs for seeing out-of-network providers
Kaiser Permanente service area
Contact Information
Trust office
(833) 389-0027
Reasons to contact the Trust office:
- Customer Service/Eligibility/Enrollment
- Submit claims
- Questions about your claims
Regence PPO
(866) 240-9580
Reasons to contact Regence PPO:
- Find a care provider
- Schedule an appointment
- Questions about switching from another plan
- Questions about your ID cards
- Replace lost ID cards
OptumRx, Inc.
(844) 368-0083
Reasons to contact OptumRx:
- Find a pharmacy near you
- What drugs are covered under your plan
- How to enroll in maintenance drugs
Kaiser Permanente HMO
1-800-813-2000
Reasons to contact Kaiser Permanente:
- Find a care provider
- Schedule an appointment
- Questions about switching from another plan
- Questions about your ID cards
- Replace lost ID cards
Learn more
Find more resources about your benefits here.
Frequently Asked Questions
Have a question about enrollment or how the plan works? Start here!
Terms to Know
Learn some of the “language” of healthcare coverage here.