Medical
Washington Health’s medical plans use a three-tier provider structure, giving you flexibility in where you receive care while helping you manage your out-of-pocket costs. Receiving services at a Washington Health facility or from a Tier 1 provider offers the lowest level of member cost, followed by Tier 2 in-network providers. Tier 3 out-of-network care generally results in the highest out-of-pocket costs and may also leave you responsible for charges above the plan’s allowable amount. Preventive care, such as annual physicals, immunizations and recommended screenings, is covered at 100% when received from eligible in-network providers. When choosing where to receive care, be sure to consider the provider’s tier, since your cost can vary depending on where services are received.
Teladoc Health
Teladoc Health gives you 24/7 access to U.S. board-certified doctors by phone or video for many common, non-emergency medical needs. Teladoc can be a convenient option when you need care quickly, are away from home, or are considering urgent care for a non-emergency condition.
Your cost: $15 copay under both plans for in-network (Tier 1 and Tier 2) benefits.
Get started: Visit Teladoc.com or call 800-TELADOC.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Unless your domestic partner qualifies as your tax dependent under IRS guidelines, contributions for their coverage must be made on an after-tax basis. Additionally, Washington Health’s contributions toward coverage for your domestic partner and their dependents will be treated as taxable income (imputed income) and reported on your W-2 Please consult your tax advisor for guidance on how this may affect your individual tax situation.
Core Choice PPO
Benefit Highlights
Tier 1 – WHMG
Providers
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$500/$1,000
Preventive Care
No charge
Primary Care Visit
$10 copy
Specialist Visit
$20 copay
Urgent Care
$25 copay
Emergency Room
$90 copay
Haller’s Pharmacy (34-Day Supply)
Generic
$3 copay
Preferred Brand
$20 copay
Non-Preferred Brand
$35 copay
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$6 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$70 copay
Specialty
Not covered
Tier 2 – Blue Shield PPO Providers
Deductible (Individual/Family)
$750/$1,500
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
No charge
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
$25 copay
Emergency Room
$90 copay
Participating Pharmacy (34-Day Supply)
Generic
$8 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Specialty
20% up to $150
Mail-Order Rx (Up to 90-Day Supply)
Generic
$16 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Specialty
Not covered
Tier 3 – Non-Preferred Providers
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
Not covered
Primary Care Visit
50%
Specialist Visit
50%
Urgent Care
50%
Emergency Room
$90 copay
Non-Participating Pharmacy (34-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Per Pay Period Plan Cost
| Full-Time | Part-Time | |
| Employee Only: | $0 | $0 |
| Employee and Spouse: | $15 | $18 |
| Employee and Child(ren): | $13 | $16 |
| Employee and Family: | $29 | $35 |
Choice Plus PPO
Benefit Highlights
Tier 1 – WHMG
Providers
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$500/$1,000
Preventive Care
No charge
Primary Care Visit
$10 copy
Specialist Visit
$20 copay
Urgent Care
$20 copay
Emergency Room
$75 copay
Haller’s Pharmacy (34-Day Supply)
Generic
$3 copay
Preferred Brand
$20 copay
Non-Preferred Brand
$35 copay
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$6 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$70 copay
Specialty
Not covered
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
No charge
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$20 copay
Emergency Room
$75 copay
Participating Pharmacy (34-Day Supply)
Generic
$8 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Specialty
20% up to $150
Mail-Order Rx (Up to 90-Day Supply)
Generic
$16 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Specialty
Not covered
Deductible (Individual/Family)
$2,500/$5,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
Not covered
Primary Care Visit
40%
Specialist Visit
40%
Urgent Care
40%
Emergency Room
$75 copay
Non-Participating Pharmacy (34-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Per Pay Period Plan Cost
| Full-Time | Part-Time | |
| Employee Only: | $55 | $66 |
| Employee and Spouse: | $96 | $115 |
| Employee and Child(ren): | $90 | $108 |
| Employee and Family: | $131 | $157 |
Search for a Tier 1 Provider
Click here, then click on Physicians and choose the specialty and distance and then filter. You may also search by clicking “Services” and searching for variety of facilities.
Spousal Waiver Credit: If you waive 2026 medical coverage for your spouse/domestic partner and provide proof they have access to medical/Rx coverage through their own employer, you will receive a credit of $75 per pay period ($1,950 per year) or you may receive $70 per pay period ($1,820 per year for as a part of Local 6). See page 6 of your benefit guide for more details.