How do I know if I am eligible for one of Regence's medical plans?

To be eligible to apply for an Individual plan, you must reside in the service area as defined by Regence BlueShield. The service area includes the Washington state counties of Clallam, Columbia, Cowlitz, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Skamania, Snohomish, Thurston, Wahkiakum, Walla Walla, Whatcom and Yakima Counties.

Selecting a Primary Care Physician/Selections Plan

In most cases, in order to receive full plan benefits, you’ll need your care coordinated by a Personal Care Provider from within the Selections network. If you make the choice to see a provider outside the Selections network, coverage is provided at a lower level (you must see a provider participating in Regence BlueShield’s Extended Network to get that lower coverage).
It’s important to understand how your Personal Care Provider can help you get the most appropriate coordinated health care. When it comes to your health, choosing a provider is perhaps one of the most important decisions you make. That’s because you’re choosing a health care partner – someone who will work with you to ensure that you and your family receive the right care at the right time.

As an Individual Selections Plan member, you’ll need to select a Personal Care Provider. Each member must designate a Personal Care Provider. You can choose from many types of providers, including:

• Family Practice, General Practice, Internal Medicine, or Pediatric physician (M.D. or D.O.)
• Advanced Registered Nurse Practitioner (A.R.N.P.) or Physician Assistant/Certified (P.A.C.) specializing in Family Practice or Pediatrics.
• Naturopath
  

Once you’ve decided the type of provider you prefer, you can choose your Personal Care Provider from Regence BlueShield’s Selections Provider Directory. You might consider whether the provider is close to where you work or live, and ask for referrals from people you trust, such as family members and friends.

Questions you may want to ask when choosing your Personal Care Provider

• Office hours? Average wait for an appointment?
• After-hours/holiday emergency care?
• Referrals to specialists?
• Pleasant, helpful office staff?
• Ease in scheduling appointments?
• Response time for return phone calls?

When you need the care of a specialist, your Personal Care Provider will refer you to an appropriate provider. This referral is necessary in order for you to receive full plan benefits – check with your Personal Care Provider or your Regence BlueShield Member Services Team representative. Once your specialty treatment is completed, you should again seek all care from your Personal Care Provider.