Health Plans

GroupHealth

GroupHealth Washington Health Insurance Plan Information

Because all health plans must now offer coverage that includes the 10 essential health benefits, health plans look more alike than ever before. So how do you decide? Choose a plan that gives you the most value — and the best price — based on the way you use health care services.

  • If you anticipate using a lot of health care services, you may want a plan with a higher monthly premium but lower out-of-pocket costs. Consider the Group Health Core Plus Gold plan.
  • If you're healthy and rarely use health care services, you may prefer a plan with lower premiums and higher out-of-pocket costs. Consider the Group Health Core Plus Bronze plan.
  • If you're under age 30 or you qualify for financial hardship (as determined on a case-by-case basis), you may want a Catastrophic plan available through Washington Healthplanfinder.
  • Want something in between? The Group Health Core Plus Silver plan may be just right for you.

Core Plans for individuals enrolling directly with Group Health

Our Core Plus Silver and Core Plus Gold plans are replacing our Core3 Silver and Core3 Gold plans. They offer the same extensive benefits as the 2014 Core3 Silver and Core3 Gold plans, plus:

  • Your first three office visits can now be used to access a combination of primary care and specialty care and will not to be subject to the deductible. (After your third visit, your deductible applies to additional non-preventive care office visits.)

In addition, we’re offering Core Plus Bronze. With a lower monthly premium than Core Plus Silver and Core Plus Gold, it offers benefits such as:

  • Your first three primary care visits are not subject to the deductible. (After your third visit, your deductible applies to additional non-preventive care office visits.)
  • Preferred generic drugs are not subject to the deductible.

Connect Plans for individuals enrolling directly with Group Health

You can access in-network care from three major health organizations in the Puget Sound region and thousands of practitioners statewide. You can choose from award-winning* doctors at Group Health Medical Centers, who are not available with any other health plan carrier, as well as physicians at Virginia Mason Medical Center and The Everett Clinic, plus any in-network provider in the state.

If you’re willing to pay higher out-of-pocket costs, you can see any out-of- network provider in the regional First Choice Health network, national First Health Network, or any other licensed provider in the U.S. And you can switch personal physicians at any time.

10 Essential Benefits

Healthcare reform says all health plans must include ten essential benefits. The basic benefits include:

  1. Outpatient Care - the kind you get without being admitted to a hospital
  2. Emergency Services - for issues that could lead to death or disable you if you do not treat them.
  3. Inpatient Care - covers room and board, tests, drugs, and care from doctors and nurses while admitted, which may include organ and tissue transplants, and hospice and respite care.
  4. Maternity and Newborn Care - care before and after your baby is born
  5. Mental Health and Substance Use Disorder Services - this includes behavioral health treatment, counseling, and psychotherapy.
  6. Prescription Drugs - covers retail, mail order, and specialty drugs.
  7. Rehabilitative and Habilitative Services - services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8. Laboratory Services - covers lab tests, X-ray services, and pathology, and imaging and diagnostics such as MRI, CT scan, and PET scan.
  9. Preventive and Wellness Services - including mammograms, colonoscopies, vaccines. Covered in full if you use in-network providers for care such as routine physicals, screening, and immunizations. Disease management coordinates care for diabetes, asthma, and other conditions.
  10. Pediatric Services - including dental care (preventive, basic, major) and vision care (eye exam, lenses, and eyewear).