Health Plans


GroupHealth Washington Health Insurance Plan Information

Our new individual and family health plans for 2016 include some with a specially selected network of proven-quality providers and some with a virtually unlimited provider network. We offer plans direct from Group Health and through Washington Healthplanfinder, the state's online exchange marketplace. Explore what we're offering in 2016 to find the plan that works for you.

  • Gold, Silver, and Bronze plans: Plans in three metal levels that span the range of cost shares and premiums.
  • HSA-compatible plans: Open your own health savings account (HSA) to use for eligible medical expenses. Offered on the Core and Access PPO networks.
  • Core and Flex plans: Offer the greatest value of all of our plans with access to the Core network of select providers. Flex plans include a specific number of office visits ("up-front visits") for just a copay as well as up-front coverage for some medications; the deductible doesn’t apply to either.
  • Access PPO plans: Offer the greatest provider choice of all of our plans. Access PPO plans that aren't HSA-compatible feature a specified number of up-front, in-network office visits for a copay and no deductible. These plans also offer up-front coverage for medications.

We work with Delta Dental of Washington to offer you dental coverage when paired with one of our 2016 medical plans.

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).