Regence · 2027
Silver 3500 Legacy
- Annual in-network deductible
- $3,500
- Metal level
- Silver
- Plan type
- EPO
- HSA-compatible plan
- No (most common)
Why this match? Both non-HSA · Same deductible · Same silver level · Different filed network
Asuris Northwest Health
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All supported filed details, including known conditions and limits. This is not the entire insurance contract. Unknown does not mean $0 or not covered.
RealValue is an EPO: routine care stays in its network, with limited emergency and approved-care exceptions outside it. Specialist referrals are not required, but some services need preauthorization.
Asuris · RealValue · Issuer 69364. Confirm current provider participation and exact coverage in the plan documents.
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Medical and prescription drug deductible | In-network tier 1 individual: $3,500 In-network tier 1 family: $3,500 per person | $7,000 per group In-network tier 1 coinsurance: 35.00% Out-of-network individual: Not Applicable Out-of-network family: per person not applicable | per group not applicable Combined in/out-of-network individual: Not Applicable Combined in/out-of-network family: per person not applicable | per group not applicable |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Maximum Out of Pocket for Medical and Drug Benefits (Total) | In-network tier 1 individual: $10,150 In-network tier 1 family: $10,150 per person | $20,300 per group Out-of-network individual: Not Applicable Out-of-network family: per person not applicable | per group not applicable Combined in/out-of-network individual: Not Applicable Combined in/out-of-network family: per person not applicable | per group not applicable |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Combined medical and drug deductibleNotes & sourceWhether covered medical and prescription costs count toward the same deductible. | Yes |
Combined medical and drug spending limitNotes & sourceWhether covered medical and prescription costs count toward the same out-of-pocket limit. | Yes |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Primary Care Visit to Treat an Injury or IllnessNotes & sourceA visit with a primary care clinician for an illness or injury. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Virtual Care - Store and Forward & Virtual Care - Telehealth Visit $10 Copay found on the Schedule of Benefits Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Specialist VisitNotes & sourceA visit with a clinician who focuses on a particular condition or area of medicine. | In-network tier 1 copay: $60.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Other Practitioner Office Visit (Nurse, Physician Assistant)Notes & sourceAn office visit with a nurse practitioner, physician assistant, or another listed clinician. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Virtual Care - Store and Forward & Virtual Care - Telehealth Visit $10 Copay found on the Schedule of Benefits Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Preventive Care/Screening/ImmunizationNotes & sourceServices intended to prevent illness or detect health problems early. | In-network tier 1 copay: No Charge In-network tier 1 coinsurance: No Charge Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Well Baby Visits and CareNotes & sourceRoutine visits to check a baby’s health and development. | In-network tier 1 copay: No Charge In-network tier 1 coinsurance: No Charge Coverage: Covered Benefit details: Human donor milk must be covered as it is covered by the state base benchmark plan. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Imaging (CT/PET Scans, MRIs)Notes & sourceAdvanced scans used to examine the inside of the body. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Laboratory Outpatient and Professional ServicesNotes & sourceLaboratory testing without inpatient admission. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
X-rays and Diagnostic ImagingNotes & sourceX-rays and other listed images used to help diagnose a health problem. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Allergy TestingNotes & sourceTests used to identify substances that trigger allergic reactions. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Not an essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Urgent Care Centers or FacilitiesNotes & sourceCare at an urgent care center for problems that need prompt attention. | In-network tier 1 copay: $60.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Emergency Room ServicesNotes & sourceEvaluation and treatment of a medical emergency in an emergency department. | In-network tier 1 copay: $400.00 Copay after deductible In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Benefit details: Supporting benefit crosswalk (SERFF submitted 2026-10-12): After $400 Copayment and In-Network Deductible, 35% Coinsurance. Copayment does not accrue toward the deductible. Out-of-network copay: $400.00 Copay after deductible Out-of-network coinsurance: 35.00% Coinsurance after deductible Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Emergency Transportation/AmbulanceNotes & sourceAmbulance or other listed transportation for an emergency. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 35.00% Coinsurance after deductible Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)Notes & sourceThe charge for using an outpatient facility, separate from a clinician’s professional fee. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Benefit details: Care provided at an in-network Ambulatory Surgery Center may be covered at a lower cost share, see Schedule of Benefits for lower cost share amount for you plan. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Outpatient Surgery Physician/Surgical ServicesNotes & sourceThe surgeon’s or other clinician’s services for surgery without inpatient admission. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Inpatient Hospital Services (e.g., Hospital Stay)Notes & sourceHospital facility services after admission as an inpatient. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Inpatient Physician and Surgical ServicesNotes & sourceClinicians’ professional services during an inpatient hospital stay. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Cosmetic SurgeryNotes & sourceSurgery mainly intended to change appearance. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Benefit details: Covers cosmetic surgery when medically necessary. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
TransplantNotes & sourceMedical care involving transplantation of an organ or tissue. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Reconstructive SurgeryNotes & sourceSurgery to restore function or repair a body part affected by injury, illness, or a birth condition. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Benefit details: Coverage for reconstructive breast surgery and treatment of congenital anomalies is required and is covered under the state base benchmark plan Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Mental/Behavioral Health Outpatient ServicesNotes & sourceMental or behavioral health care without inpatient admission. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Virtual Care - Store and Forward & Virtual Care - Telehealth Visit $10 Copay found on the Schedule of Benefits. Outpatient office/psychotherapy visits - Copayment, Deductible waived. Other outpatient services - Coinsurance after Deductible Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Mental/Behavioral Health Inpatient ServicesNotes & sourceMental or behavioral health treatment during an inpatient stay. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Substance Abuse Disorder Outpatient ServicesNotes & sourceTreatment for substance use disorders without inpatient admission. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Benefit details: Virtual Care - Store and Forward & Virtual Care - Telehealth Visit $10 Copay found on the Schedule of Benefits. Outpatient office/psychotherapy visits - Copayment, Deductible waived. Other outpatient services - Coinsurance after Deductible Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Substance Abuse Disorder Inpatient ServicesNotes & sourceTreatment for substance use disorders during an inpatient stay. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Generic DrugsNotes & sourceMedicines classified by the plan as generic drugs. | In-network tier 1 copay: $20.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 90 Limit unit: Days per Month Benefit details: Coverage is limited to a 30-day supply retail or 90-day supply mail order per fill or refill. For prescription contraceptive drugs coverage includes a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. Insulin limit: $35 for a 30 day supply and $105 for a 90 day. Benefit details: Supporting benefit crosswalk (SERFF submitted 2026-10-12): $20 Copayment, Deductible waived for each Preferred Generic Medication. Copayment does not accrue toward the deductible: $35 Copayment, Deductible waived, for each Generic Medication. Copayment does not accrue toward the deductible: Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Preferred Brand DrugsNotes & sourceBrand-name medicines placed in the plan’s preferred drug category. | In-network tier 1 copay: $60.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 90 Limit unit: Days per Month Benefit details: Coverage is limited to a 30-day supply retail or 90-day supply mail order per fill or refill. For prescription contraceptive drugs coverage includes a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. Insulin limit: $35 for a 30 day supply and $105 for a 90 day. Benefit details: Supporting benefit crosswalk (SERFF submitted 2026-10-12): $60 Copayment, Deductible waived, for each Preferred Brand-Name Medication. Copayment does not accrue toward the deductible: Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Non-Preferred Brand DrugsNotes & sourceBrand-name medicines outside the plan’s preferred drug category. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 50.00% Coverage: Covered Service limit: Yes Limit amount: 90 Limit unit: Days per Month Benefit details: Coverage is limited to a 30-day supply retail or 90-day supply mail order per fill or refill. For prescription contraceptive drugs coverage includes a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. Insulin limit: $35 for a 30 day supply and $105 for a 90 day. Benefit details: Supporting benefit crosswalk (SERFF submitted 2026-10-12): 50% Coinsurance, Deductible waived, for each Brand-Name Medication. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Specialty DrugsNotes & sourceMedicines placed in the plan’s specialty category, often requiring special handling or monitoring. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coinsurance after deductible Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Month Benefit details: First fill allowed at a retail pharmacy. Additional fills must be provided at a specialty pharmacy. Coverage is limited to a 30-day supply for specialty and self-administrable cancer chemotherapy medications from a specialty pharmacy per fill or refill. Benefit details: Supporting benefit crosswalk (SERFF submitted 2026-10-12): 20% Coinsurance for each Preferred Specialty Medication; 50% Coinsurance for each Specialty Medication. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Supply limits and coverage conditionsNotes & sourceRetail, mail-order and specialty prescription terms, with the source drug tiers and exceptions retained. | Generic Drugs; Preferred Brand Drugs · Benefit details: Coverage is limited to a 30-day supply retail or 90-day supply mail order per fill or refill. For prescription contraceptive drugs coverage includes a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. Insulin limit: $35 for a 30 day supply and $105 for a 90 day. Non-Preferred Brand Drugs · Benefit details: Coverage is limited to a 30-day supply retail or 90-day supply mail order per fill or refill. For prescription contraceptive drugs coverage includes a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. Insulin limit: $35 for a 30 day supply and $105 for a 90 day. Specialty Drugs · Benefit details: First fill allowed at a retail pharmacy. Additional fills must be provided at a specialty pharmacy. Coverage is limited to a 30-day supply for specialty and self-administrable cancer chemotherapy medications from a specialty pharmacy per fill or refill. |
Formulary tier 1Notes & sourceFiled formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply. | Drug category: Preferred Generic Three-month in-network mail order: Yes |
Formulary tier 2Notes & sourceFiled formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply. | Drug category: Generic Three-month in-network mail order: Yes |
Formulary tier 3Notes & sourceFiled formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply. | Drug category: Preferred Brand Three-month in-network mail order: Yes |
Formulary tier 4Notes & sourceFiled formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply. | Drug category: Brand Three-month in-network mail order: Yes |
Formulary tier 5Notes & sourceFiled formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply. | Drug category: Preferred Generic, Preferred Brand, Specialty Drugs Three-month in-network mail order: No |
Formulary tier 6Notes & sourceFiled formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply. | Drug category: Generic, Brand, Specialty Drugs Three-month in-network mail order: No |
Formulary tier 7Notes & sourceFiled formulary tier. Mail-order availability refers to three-month in-network supply; coverage, supply limits and medication requirements still apply. | Drug category: Medical Service Drugs Three-month in-network mail order: No |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Prenatal and Postnatal CareNotes & sourceCare during pregnancy and after childbirth. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Delivery and All Inpatient Services for Maternity CareNotes & sourceCare for childbirth and related inpatient services. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Abortion for Which Public Funding is ProhibitedNotes & sourceThe filing’s category for abortion services that cannot receive public funding. | In-network tier 1 copay: No Charge In-network tier 1 coinsurance: No Charge Coverage: Covered Benefit details: Coverage includes termination of pregnancy for all members. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Hospice ServicesNotes & sourceCare focused on comfort and support near the end of life. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Service limit: Yes Limit amount: 14 Limit unit: Days per Lifetime Benefit details: Limit applies to respite care only Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Home Health Care ServicesNotes & sourceMedical care delivered at home under a care plan. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Service limit: Yes Limit amount: 130 Limit unit: Visit(s) per Year Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Skilled Nursing FacilityNotes & sourceCare in a facility providing skilled nursing or rehabilitation. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Service limit: Yes Limit amount: 60 Limit unit: Days per Year Benefit details: Coverage is limited to 60-inpatient days/year. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Outpatient Rehabilitation ServicesNotes & sourceTherapy to help restore abilities after illness or injury without inpatient admission. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 25 Limit unit: Visit(s) per Year Benefit details: Limit combined with Occupational, Physical, and Speech therapy. Visit limit does not apply to Mental Health/Substance Abuse. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Habilitation ServicesNotes & sourceTherapy to help develop or maintain skills needed for daily activities. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Year Benefit details: Coverage for habilitative services is limited to 30-inpatient days/year. Coverage for habilitative services is limited to 25-outpatient visits/year. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Rehabilitative Speech TherapyNotes & sourceTherapy to restore speech, communication, or swallowing abilities. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Year Benefit details: Coverage is limited to 30-inpatient days/year and 25-outpatient visits/year. Rehabilitative Speech Therapy and Rehabilitative Occupational and Rehabilitative Physical Therapy combine for 25 visits for Rehabilitative Services and 25 visits for Habilitative Services. Visit limit does not apply to Mental Health/Substance Abuse. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Rehabilitative Occupational and Rehabilitative Physical TherapyNotes & sourceTherapy to restore movement or the ability to carry out everyday tasks. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 30 Limit unit: Days per Year Benefit details: Coverage is limited to 30-inpatient days/year and 25-outpatient visits/year. Rehabilitative Speech Therapy and Rehabilitative Occupational and Rehabilitative Physical Therapy combine for 25 visits for Rehabilitative Services and 25 visits for Habilitative Services. Visit limit does not apply to Mental Health/Substance Abuse. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Infusion TherapyNotes & sourceTreatment that delivers medicine or fluids through a needle or catheter. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Benefit details: Covered under applicable benefit (such as office visit). Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Durable Medical EquipmentNotes & sourceMedical equipment for repeated use, such as a wheelchair or home oxygen equipment. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Infertility TreatmentNotes & sourceMedical services to evaluate or treat difficulty becoming pregnant. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Exclusions: Only evaluations to determine if and why a covered member is infertile and artificial insemination are covered. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Chiropractic CareNotes & sourceCare provided by a chiropractor, including listed spinal or joint treatments. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Service limit: Yes Limit amount: 10 Limit unit: Visit(s) per Year Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Hearing AidsNotes & sourceDevices that help improve hearing. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: No Charge Coverage: Covered Service limit: Yes Limit amount: 1 Limit unit: Item(s) per 3 Years Benefit details: Coverage is limited to one hearing aid per ear every 3 years. Cochlear Implants for children are also covered. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Routine Foot CareNotes & sourceRegular foot care, such as listed nail or callus services. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
AcupunctureNotes & sourceTreatment using thin needles placed at specific points on the body. | In-network tier 1 copay: $40.00 In-network tier 1 coinsurance: Not Applicable Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
DialysisNotes & sourceTreatment that filters the blood when the kidneys cannot do so adequately. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
ChemotherapyNotes & sourceDrug treatment used for cancer and certain other conditions. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Benefit details: Covered under the base benchmark plan. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
RadiationNotes & sourceTreatment using targeted radiation, commonly for cancer. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Benefit details: Covered under the base benchmark plan; covered under applicable benefit (such as office visit). Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Diabetes EducationNotes & sourceInstruction to help a person manage diabetes. | In-network tier 1 copay: No Charge In-network tier 1 coinsurance: No Charge Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Prosthetic DevicesNotes & sourceDevices that replace a missing body part. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Temporomandibular joint (TMJ) treatmentNotes & sourceTreatment for problems affecting the jaw joint and nearby muscles. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Nutritional CounselingNotes & sourceProfessional guidance on food choices and nutrition. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Diabetes Care ManagementNotes & sourceCoordinated support for managing diabetes and its treatment. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Inherited Metabolic Disorder - PKUNotes & sourceCare for phenylketonuria, an inherited condition affecting how the body processes part of dietary protein. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Gender Affirming CareNotes & sourceHealth services that support a person’s gender identity. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Benefit details: Gender Affirming Care includes health care services prescribed to treat any condition related to the individual's gender identity and may include primary care visits, specialty care, outpatient mental health services, prescription drug benefits, and surgical services. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Other Law/Regulation Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Hearing examsNotes & sourceAssessments of hearing; consult the filed benefit for limits and member costs. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: No Charge Coverage: Covered Benefit details: Coverage is limited to an initial assessment and one annual hearing exam. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: No |
Bariatric SurgeryNotes & sourceListed in the source exclusion summary. Check its exceptions and the issued contract for the exact terms. | Source statement: Bariatric Surgery is listed in the source exclusions; review the qualifications. Source exclusion context: The 2027 sample SBC generally excludes bariatric surgery; cosmetic surgery except congenital anomalies; adult dental care; infertility treatment; long-term care; non-emergency care outside the U.S.; private-duty nursing; routine adult eye care; and weight-loss programs. The sample booklet preserves specified artificial-insemination services and infertility diagnostic procedures under Other Professional Services. This is a partial list with exceptions; consult the issued contract for full terms. |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Routine Eye Exam for ChildrenNotes & sourceRegular vision exams for children. | In-network tier 1 copay: No Charge In-network tier 1 coinsurance: No Charge Coverage: Covered Service limit: Yes Limit amount: 1 Limit unit: Exam(s) per Year Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Eye Glasses for ChildrenNotes & sourcePrescription eyeglasses for children. | In-network tier 1 copay: No Charge In-network tier 1 coinsurance: No Charge Coverage: Covered Service limit: Yes Limit amount: 1 Limit unit: Item(s) per Year Benefit details: Coverage is limited to one frame and one pair (two lenses)/ calendar year or contacts (in lieu of glasses). Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Dental Check-Up for ChildrenNotes & sourceRoutine dental exams for children. | In-network tier 1 copay: No Charge In-network tier 1 coinsurance: No Charge Coverage: Covered Service limit: Yes Limit amount: 2 Limit unit: Visit(s) per Year Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Basic Dental Care - ChildNotes & sourceDental services classified as basic care for children, such as listed fillings. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 20.00% Coverage: Covered Service limit: Yes Limit amount: 2 Limit unit: Exam(s) per Year Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Orthodontia - ChildNotes & sourceTreatment to align children’s teeth or jaws, such as braces. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 50.00% Coverage: Covered Benefit details: Medically necessary orthodontia must be covered. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Major Dental Care - ChildNotes & sourceDental services classified as major care for children. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 50.00% Coverage: Covered Benefit details: Quantitative limits apply; see essential health benefits base benchmark plan. Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential health benefit: Yes Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
Dental AnesthesiaNotes & sourceAnesthesia used during dental treatment. | In-network tier 1 copay: Not Applicable In-network tier 1 coinsurance: 35.00% Coinsurance after deductible Coverage: Covered Out-of-network copay: Not Applicable Out-of-network coinsurance: 100.00% Essential benefit variation: Additional essential health benefit Excluded from in-network spending limit: No Excluded from out-of-network spending limit: Yes |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Provider networkNotes & sourceThe insurer’s name for the network linked to this plan. Check the current provider directory to confirm a doctor or hospital participates. | RealValue |
Specialist referralNotes & sourceWhether the plan generally requires a referral before seeing a specialist. Check the listed exceptions. | No |
Referral detailsNotes & sourceThe insurer’s explanation of when specialist referrals are needed. | The 2027 Asuris sample booklet says referrals are not required before using covered benefits. Some covered services require preauthorization by contracted providers. Medical-necessity and network rules still apply; consult the issued booklet for service-specific requirements. |
Provider tiersNotes & sourceWhether in-network providers are grouped into tiers with different member costs. | No |
National networkNotes & sourceWhether the filing lists a national provider network; this does not confirm any particular provider participates. | No |
Care outside the countryNotes & sourceWhether the filing lists coverage outside the country; restrictions may apply. | No |
International care detailsNotes & sourceThe insurer’s explanation of coverage and restrictions outside the country. | The 2027 sample SBC excludes non-emergency care while traveling outside the U.S. For any covered services received outside the U.S., the sample booklet warns that state/federal surprise- or balance-billing protections may not apply. These notes do not expand the RealValue EPO’s limited out-of-network benefits; confirm emergency travel terms with Asuris. |
Care outside the service areaNotes & sourceWhether the filing lists coverage away from the plan’s normal service area. | No |
Outside-area care detailsNotes & sourceThe insurer’s explanation of care covered away from the normal service area. | RealValue EPO: the 2027 sample booklet requires in-network providers for covered services. Out-of-network services are not covered except for ambulance and emergency-room services under the booklet’s terms. The filed service area describes where this plan is sold, not a promise that any provider elsewhere participates. Confirm providers and travel benefits with Asuris before non-emergency care. |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
HSA-compatible planNotes & sourceWhether the filing identifies the plan as HSA-compatible; your personal ability to contribute also depends on other rules. | No |
Filed employer account contributionNotes & sourceWhether the plan filing includes an employer HSA or HRA contribution; it does not describe your employer’s actual contribution. | No |
HSA in source plan nameNotes & sourceSource name evidence only; this does not establish personal HSA eligibility. | No |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Wellness programNotes & sourceWhether the filing lists a program intended to support healthy habits. | No |
Condition support programsNotes & sourcePrograms listed to help members manage ongoing health conditions. | Case management for serious illness or injury with potential continuing major or complex care needs. Licensed health-care professionals provide information, support and guidance, coordinate with treating professionals, and may propose alternative benefits. See the 2027 sample booklet and contact Asuris for applicable services. |
Unique plan designNotes & sourceWhether the insurer marked the benefit design as distinct in its filing. | Yes |
Plan exclusionsNotes & sourceServices or situations the insurer lists as excluded from coverage. | The 2027 sample SBC generally excludes bariatric surgery; cosmetic surgery except congenital anomalies; adult dental care; infertility treatment; long-term care; non-emergency care outside the U.S.; private-duty nursing; routine adult eye care; and weight-loss programs. The sample booklet preserves specified artificial-insemination services and infertility diagnostic procedures under Other Professional Services. This is a partial list with exceptions; consult the issued contract for full terms. |
Pregnancy noticeNotes & sourceWhether the filing indicates a pregnancy-related notice requirement. | No |
Child-only coverageNotes & sourceHow the filing describes coverage offered for children without an enrolled adult. | Allows Adult and Child-Only |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Having a baby example | Example deductible: $3,500 Example copays: $10 Example coinsurance: $3,100 Example uncovered costs: $60 |
Managing diabetes example | Example deductible: $900 Example copays: $800 Example coinsurance: $0 Example uncovered costs: $200 |
Simple fracture example | Example deductible: $1,700 Example copays: $700 Example coinsurance: $0 Example uncovered costs: $0 |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Calculated actuarial valueNotes & sourceAn estimate of the share of covered costs the plan pays for a standard population, not your expected spending. | 0.728383328384015 |
Insurer actuarial valueNotes & sourceThe insurer’s estimate of the plan’s share of covered costs for a standard population. | 70.91% |
Tier 1 filing assumptionNotes & sourceThe use of tier 1 providers assumed in the filing, not a prediction of your care. | 100% |
Composite premium availableNotes & sourceWhether the filing offers a shared premium rate instead of separate age-based rates. | No |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Plan IDNotes & sourceThe identifier used to distinguish this plan in the filing. | 69364WA1240003 |
Plan variation IDNotes & sourceIdentifies this plan’s specific version of benefits and cost sharing. | 69364WA1240003-00 |
Plan variation nameNotes & sourceThe insurer’s name for this version of the plan. | Asuris Silver 3500 RealValue |
Cost-sharing variationNotes & sourceThe filed category for this version of the plan’s member costs. | Standard Silver Off Exchange Plan |
Product IDNotes & sourceThe identifier for the product family this plan belongs to. | 69364WA124 |
Network IDNotes & sourceIdentifies this plan’s provider network within this insurer’s filing. | WAN003 |
Service area IDNotes & sourceIdentifies the area where the insurer offers this plan. | WAS003 |
Drug list IDNotes & sourceIdentifies the prescription drug list referenced by this plan. | WAF010 |
Marketplace statusNotes & sourceWhether the filing describes the plan as offered through the health insurance marketplace. | Off the Exchange |
New or existing planNotes & sourceWhether the insurer filed this as a new or continuing plan. | Existing |
Effective dateNotes & sourceThe start date listed for this plan in the filing. | 1/1/2027 |
Plan name | Asuris Silver 3500 RealValue |
Legal issuer | Asuris Northwest Health |
Plan type | EPO |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Virtual care options | 2027 sample booklet: telehealth (live remote visits) and store-and-forward services (asynchronous care) have an in-network cost share of $10 Copay, Deductible waived. This RealValue EPO has in-network virtual-care benefits only; its limited ambulance/emergency-room exceptions are not general out-of-network virtual coverage. Some providers may offer lower cost sharing; confirm the provider and service with Asuris. Separate facility fees use the Other Professional Services benefit. |
| Benefit | Asuris Silver 3500 RealValue |
|---|---|
Specialty drug coinsurance capHow costs are shared | Not supplied in selected filing |
Hospital copay day limitHow costs are shared | Unknown |
Primary care visits before cost sharingHow costs are shared | Not supplied in selected filing |
Primary care copays before other chargesHow costs are shared | Unknown |
Filed contribution amountHealth accounts | Not supplied in selected filing |
Plan designPlan features and exclusions | Unknown |
Adult dental waiting periodPlan features and exclusions | Not supplied in selected filing |
Waiting period lengthPlan features and exclusions | Not supplied in selected filing |
Tier 2 filing assumptionFiling assumptions | Unknown |
Essential benefit premium shareFiling assumptions | Not supplied in selected filing |
Children’s dental allocationFiling assumptions | Not supplied in selected filing |
Rate descriptionFiling assumptions | Not supplied in selected filing |
Child-only plan IDPlan identifiers and filing context | Not supplied in selected filing |
Tribal cost-sharing variationPlan identifiers and filing context | Not supplied in selected filing |
Expiration datePlan identifiers and filing context | Unknown |
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Search 2027 plans only. Availability depends on your county and coverage start.
2027 · Public plan ID 69364WA1240003 · Benefit variant 69364WA1240003-00
Original identity review: 2027 Asuris sample SBC. The enrolled coverage period is a placeholder; this is not an executed group contract. The catalog’s network county list includes Columbia and Walla Walla, which this plan’s filed service area and sample booklet do not include. Network footprint is not enrollment eligibility; confirm eligibility with Asuris. Local copy retained; extracted text is review evidence, not a reconciled coverage contract.
Carrier source index; formats and available documents vary. 2027 Asuris sample SBC. The enrolled coverage period is a placeholder; this is not an executed group contract. The catalog’s network county list includes Columbia and Walla Walla, which this plan’s filed service area and sample booklet do not include. Network footprint is not enrollment eligibility; confirm eligibility with Asuris.
Original identity review: 2027 Asuris medical benefit summary, January 1–December 31, 2027. Read with the sample SBC and booklet; this is not the issued group contract. The catalog’s network county list includes Columbia and Walla Walla, which this plan’s filed service area and sample booklet do not include. Network footprint is not enrollment eligibility; confirm eligibility with Asuris. Local copy retained; extracted text is review evidence, not a reconciled coverage contract.
Original identity review: 2027 Asuris sample benefit booklet with an exact-title benefit schedule. Group name, cover plan name, group number and enrolled effective date contain placeholders; confirm the issued contract and current provider participation. The catalog’s network county list includes Columbia and Walla Walla, which this plan’s filed service area and sample booklet do not include. Network footprint is not enrollment eligibility; confirm eligibility with Asuris. Local copy retained; extracted text is review evidence, not a reconciled coverage contract.
Adams, Asotin, Benton, Chelan, Douglas, Ferry, Franklin, Garfield, Grant, Kittitas, Lincoln, Okanogan, Pend Oreille, Spokane, Whitman. Availability still depends on the coverage start and employer eligibility.
Estimate this plan and compare alternatives here, with the existing comparison PDF.