Your Card Your Health Member GuideYour card. Your health.
1 The LifeWise ID Card 2 Your Benefits 3 Access the Network 4 Unexpected Events 5 Live a Healthy Life 6 Exams, Screenings, Immunizations 7 Prevent Disease 8 Decision Support 9 Prescriptions 11 Claims and EOBs
inside
We understand that you’re the one who makes decisions about your lifestyle,
preventive care and treatment. We’re here to help you.
As your health plan, we serve you by providing financial coverage—plus a wide range of services to help you maintain or improve your everyday health and get the greatest value when you need care.
This guide will show you highlights of the many ways you can use your health plan to your advantage. Always carry your card with you and present it to doctors, pharmacists, and other providers when you seek care.
Note: The sample card here and on the cover may not match what appears on your card, as benefits differ by plan.
lifewisewa.com Lifewisewa.com makes it easy to take control
of your health. In just a few clicks you can view
your benefits, recent claims and much more.
secure • personalized • available 24/7.
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Knowing your benefits saves you time and money. Your benefits are easy to find—just go online at lifewisewa.com and log in to myLifeWise. Taking a few minutes to register and learn about your plan could mean big savings down the road.
Need a new card, or other help? Log in at lifewisewa.com to order a new card or call our Customer Service Team at 1-800-592-6804 between 8 a.m. – 5 p.m., Monday – Friday.
Here are some definitions to help you understand your benefits:
Benefit: The portion of services your health plan pays.
Deductible: This is the amount of money you pay every year before the plan pays for certain services.
Coinsurance: Your share of the fee for a service. If your plan’s coinsurance share for a covered service is 20%, you pay 20% of the allowable amount and your plan pays the other 80% (after you meet your deductible).
Coinsurance maximum: A limit after which your plan pays at 100% of the allowable amount.
Copayment: A flat fee you pay at the time a service is rendered. Copays don’t apply toward a deductible or coinsurance maximum.
Covered services: The healthcare services and supplies for which your health plan provides benefits.
Covered-in-full services: The healthcare services that do not require a copayment or deductible to be paid by you. Your health plan pays the full amount owed to the provider.
Allowable amount: The maximum amount LifeWise will pay for a covered service.
Out-of-pocket maximum: The most you will pay toward your deductible and coinsurance for covered services during a calendar year.
Your deductible + coinsurance max = your out-of-pocket total.
Let’s say you went snowboarding and hurt your ankle. The X-ray reveals a bad break and you need surgery to fix it. Here’s how your health plan shares costs with you, when you visit a network provider:
4 Your deductible is $1,000 This is the amount you’ll pay before your plan benefits kick in.
4 Your coinsurance share is 20% That means you pay 20% of the cost, after you’ve paid your deductible.
4 The plan’s coinsurance share is 80% The plan pays the remaining 80% of your bill.
The total cost for the X-ray, hospital stay, and surgery is $13,600. You pay $3,520 (that’s your $1000 deductible + your 20% coinsurance share) and your plan pays $10,080 (80% coinsurance). Having a health plan saved you more than $10,000—not bad!
Your share Plan’s share
$120 coinsurance
$1000 deductible
$400 coinsurance
$2000 coinsurance
$480 coinsurance
$1600 coinsurance
$8000 coinsurance
$3000
$10,000
How it works: Here’s an example of how you might share
costs with your plan in the event of an injury*.
* Please note this is only an example. Actual coverage varies by plan.
Access our network to get the care you need. Your medical benefits allow you to get care from a
broad array of physicians and specialists without
the need for referrals.
YOUr CArD. YOUr PrOTECTION.
1-800-592-6804.
At home, across the country, and around the world—LifeWise is with you. Our network is built on our strong relationships with providers, hospitals and specialists. As a LifeWise member, you can see any network provider. They have agreed to bill us directly and accept our maximum allowable amount for covered services. Providers who are not in our network (out-of-network providers) may bill over our maximum allowable amount and hold you responsible for the additional costs. By using a network provider, you’ll get the highest level of benefits and lowest out-of-pocket costs.
How do I find a network provider? As a LifeWise member, you have access to a comprehensive network of providers.
What if I’m in Oregon, Washington or Alaska? With thousands of privately contracted physicians, hospitals and other healthcare professionals in Oregon, Washington and Alaska, the provider you want to see may already be in our network. Just click on “Find a Doctor” at lifewisewa.com to be sure.
What if I happen to be in other states? For providers in other states, click on “Find a Doctor” at lifewisewa.com. For assistance by phone, call 1-800-592-6804.
What if I am out of the country? For outpatient or inpatient care outside the U.S., you pay the provider and then submit your claim to LifeWise Health Plan of Washington. Follow the steps listed under “Filing a claim with an out-of-network provider” on page 13.
What happens when I use an out-of-network provider? Out-of-network providers have not made an agreement with us about fees for services to our members, so you will most likely be subject to higher costs and more paperwork. To learn more about filing a claim with an out-of-network provider, go to page 13.
Call 911 or go to the emergency room if you are in severe pain or your condition is endangering your life.
Examples of medical emergencies include:
• suspected heart attacks
Life ThreaTeningnoT sure whaT To do?
Urgent care facilities provide quick, convenient care for health needs that aren’t life threatening but can’t wait until the next day or longer. They are open outside of regular business hours and are less expensive than emergency room care.
Examples of conditions that can be dealt with in an urgent care facility include:
• ear infections
• low fever or mild flu symptoms
• minor rashes, cuts, bites and sprains
Call the FREE 24-Hour NurseLine at 1-800-841-8343 to speak to a registered nurse who will ask the right questions, listen to your concerns, and help you determine where and when to seek treatment.
non-Life ThreaTening
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Get the right care in the event of an accident or unexpected illness. Your plan provides coverage for unexpected health events. Here are our suggestions
to help you get the right care while avoiding unnecessary out-of-pocket costs.
Should I call a nurse, seek urgent care or go to the ER? Sometimes it’s hard to know which to choose, but there’s a big difference in time and money. If your condition is not life-threatening, you can either call our FREE and CONFIDENTIAL 24-Hour NurseLine or visit an urgent care facility. If your condition is life-threatening, you should call 911 or go to the emergency room immediately.
Here are some criteria to help you decide:
NON-LIFE THREATENINg: URgENT CARE
To find an urgent care facility near you, go to lifewisewa.com and
1) Click on “Find a Doctor”, then select “Individual and Family Members” or “Employer or group Members”
2) Select “By Specialties” under “Facilities”
3) Choose “Urgent Care” under “More Specialties” list
4) Narrow search by selecting other items
Or, you can call our Customer Service Team at 1-800-592-6804.
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YOUr CArD. YOUr WELLBEINg.
Live a healthy life. We want our members to take advantage of the best defenses against disease—
healthy living, prevention, early detection and immunizations. That’s why many of
our plans have covered-in-full preventive care benefits.
Take advantage of preventive exams and screenings Most LifeWise plans cover specified preventive screenings and immunizations in full, with little or no coinsurance. So take advantage of these benefits that can prevent illness and disease, especially when they cost you little or nothing out-of-pocket.
Check your benefits online at lifewisewa.com to see what is covered. As the saying goes, an ounce of prevention is worth a pound of cure. This is true not just in childhood, when we get most of our immunizations against preventable diseases, but also in adulthood, when routine exams and screenings can play a crucial role in early detection and prevention.
3 things to remember
Check your benefits online to find out what
is covered.
get SCREENED
screening tests.
get VACCINATED
vaccinations.
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Exams and screenings Many routine tests may be covered by your health plan, from newborn exams and vaccinations to physicals needed for work or school. The following schedule for routine check-ups will help you keep up with recommended screenings and exams:
AgE WHEN TO gET A CHECK-UP
0-24 months In the first 2-7 days and 2, 4, 6, 9, 12, 15, 18 and 24 months of age
3-18 years Every 2 years
19-64 years Every 1-3 years
65+ Annually
Immunizations Vaccines offer protection from illness and disease. The U.S. Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices issue recommendations for vaccinations that will protect you from diseases such as Hepatitis B, pneumonia and chicken pox. Children and Adolescents should receive a range of vaccinations and follow-up doses from birth to age 18. Adults 19 and older need some additional follow-up doses, and adults over 50 should get a yearly flu shot.
IMMUNIZATIONS
Visit us at lifewisewa.com/immunizations to get up-to-date recommendations, and check
with your doctor to make sure your family’s immunizations are current.
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YOUr CArD. YOUr DECISIONS.
Prevent disease. Lifestyle choices are at the root of many chronic illnesses, with tobacco
use topping the list, followed by a lack of physical activity and poor
nutrition. The more you know, the more power you have to make
healthy choices. Preventive screenings are a great way to spot changes
that may mean a change in your health.
TEST/SCREENINg IDEAL WHEN TO gET TESTED
Blood pressure 120/80 Every 1-3 years for adults 18 and older
Blood glucose level (fasting)
Cholesterol <200 Men—Beginning at age 35, every 1-5 years
Women—Beginning at age 45, every 1-5 years
Breast cancer (Mammogram)
-- Every 1-2 years for women, beginning at age 40
Cervical cancer -- Begin when sexually active, but not later than age 21, every 1-3 years until age 65
Colon cancer -- All women and men beginning at age 50
Your doctor can help you get up-to-date with these tests and screenings:
STAYINg HEALTHY
Visit us online and log in at lifewisewa.com to take advantage of tips and tools
for a healthy lifestyle.
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Make informed decisions. Here are some tools to help you understand your medical concerns, have more effective
conversations with your provider, and make informed healthcare choices.
FREE 24-Hour NurseLine: 1-800-841-8343 Our registered nurses are available any time of the day or night to speak with you. They will ask the right questions, listen to your concerns, and help you determine where and when to seek treatment.
Health & Symptom Evaluation tools*
Understand more about your health and how to take care of it.
Take the Health Assessment to find out your real “health age” and learn what you need to make smart healthful choices.
The Personal Evaluation System (PES) helps you figure out what your symptom may be and what to
do about it.
Treatment Cost Calculator Find out the cost of a procedure, lab test or consultative health visit with our Treatment Cost Calculator to help you plan for future healthcare spending.
Health Helpers tools*
Lead your health in the right direction.
Includes the 12-week Healthy Living program to practice lifestyle habits that improve your health, Quizzes to test your health IQ, Calculators to learn more about your health, and Health Trackers to observe your health over time.
myLifeWise
lifewisewa.com
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Choose the best medication for your health and budget. Medication is necessary for many treatment plans, but it can be expensive. By using
our pharmacy network, you avoid claims paperwork and you may also save money.
5 easy ways to save money on medication
1. Order by Mail Ordering medication by mail can save you time and money. Our mail program offers the convenience of home delivery while maximizing your ability to choose the most cost-effective medications through MyPharmacyPlus. You can order your routine medications over the phone, through the Web, by mail or fax—it’s truly that simple! You can even talk to a pharmacist who is specially trained in your medical condition.
2. Say Yes! to generics Maybe you’ve already heard about generic drugs in the news: It’s true, they are less expensive than brand- name drugs and the U.S. Food & Drug Administration says they are just as effective. Ask your doctor to write prescriptions for generic drugs whenever possible.
3. Look Up Medication Alternatives MyPharmacyPlus is an online search tool that can help you find less expensive medication alternatives. Now, you and your doctor can choose the medications that fit both your health and your budget.
Just go to lifewisewa.com/mypharmacyplus to learn more.
4. Cut the Pill, Cut Your Bill The cost to you for a medication may be the same whether your doctor prescribes a high or low dosage. It makes good economic sense in that case to order the higher dosage medication and split the pill in half, ensuring a longer supply. Talk to your doctor to see if this is right for you.
5. Specialty Pharmacy If you are being treated for a complex or rare condition requiring the use of high-cost (often self-injected) specialty drugs, your coverage requires that those prescriptions be filled by one of our contracted Specialty Pharmacy providers. Our Specialty Pharmacies are experts in helping you manage your special needs while providing you easy access, cost- savings, and convenient home delivery—ensuring you have the best possible treatment outcomes.
Call Customer Service at 1-800-592-6804 to learn how to receive these benefits or go to lifewisewa.com/specialtypharmacy.
PREFERRED DRUg LIST
Search the Preferred Drug List at lifewisewa.com/pharmacy to find the
most affordable and effective medication for your health needs.
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Visit the online Provider Directory to find a network pharmacy At lifewisewa.com, click on “Find a Doctor” to find a participating pharmacy in your area.
Manage your Prescriptions Go to lifewisewa.com/mypharmacyplus to manage your prescriptions online:
• Look up drug costs and copays
• Review your benefits and drug history
• Get detailed drug information
• Refill your prescriptions online or call 1-800-4-REFILL (1-800-473-3455).
Note: Some LifeWise plans may not have prescription drug coverage, but you are eligible for our Pharmacy Discount Program. Call 1-800-391-9701 to find out more.
Understand claims payments.
YOUr CArD. YOUr COvErAgE.
Soon after a claim is submitted, you’ll receive a breakdown of the charges submitted
to LifeWise Health Plan of Washington, with details showing what we pay for and what
portion, if any, you are responsible for. This is your Explanation of Benefits (EOB).
February 2, 2009
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10987654321 11
ELECTRONIC EOB
go paperless! You can sign up and access your EOB
electronically on our secure member portal at
lifewisewa.com/eob
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Service/product description—type of service/ product you received from your provider.
Dates you received service/product— when you saw your provider (month/day/year to month/day/year).
Charges billed by provider —amount billed to you and your healthcare plan(s).
Provider’s fee adjustment—difference between “charges billed by provider” and the amount network providers have agreed to accept as full payment.
Your copay, deductible or amount not covered—“copay” is a set fee you pay a provider at each visit; “deductible” is how much you pay each year before the health plan pays; “amount not covered” applies to services/products not covered by your plan; see “Message Codes” at the bottom of your EOB for details.
Total amount eligible for benefits—“charges billed by provider” minus “provider fee adjustment” minus “your copay, deductible or amount not covered.”
%—the percentage your plan pays for covered services/products.
Your coinsurance amount—what you must pay the provider after we pay the covered percentage.
Adjustment—see explanation(s) at the bottom of your EOB for details.
Total paid by your plan—“total amount eligible for benefits” minus “your coinsurance amount.”
Amount you’re responsible for—what you must pay of the billed charges after plan benefits are paid.
Surgery—anything invasive to your body (e.g. blood draw, mole removal, biopsy).
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4
3
2
5
12
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9
8
7
6
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When you see a network provider in the LifeWise network, the provider sends the bill
directly to us for payment. This is your claim, of which you may either pay nothing or a
portion, depending on your covered services, deductible, and coinsurance.
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Filing a claim with an out-of-network provider When you see a provider or use a pharmacy outside the network, you have to submit the claim yourself after paying for the service up front (network providers submit the claim for you).
To file a claim:
1. Complete a claim form. To get a claim form download one from the “Forms” section at lifewisewa.com or call 1-800-592-6804 to have one mailed to you.
2. Attach an itemized bill from the provider for the covered service.
3. Make a copy for your records.
4. Mail your claim to the address on the claim form.
Get the answers you need. We believe that the better you understand your health plan, the more you will benefit
from it. This information will help you navigate the claims process.
Claim Appeals If you would like a review of your processed claim, just call Customer Service at 1-800-592-6804. You must make your request within 180 days after you receive your EOB. You can also submit a request in writing. Include a copy of the EOB in question and any other documentation that may support your inquiry. Make sure that you send in this request within 180 days of receiving the EOB. Send your request to:
LifeWise Health Plan of Washington PO Box 91059 Seattle, WA 98111-9159
Once we receive your request, we’ll send you more details about the review process.
Questions? Call Customer Service at 1-800-592-6804. They’re ready to help you! Customer Service staff is available 8 a.m. to 5 p.m., Monday through Friday, Pacific Time. Whenever you call, please have your ID card handy.
YOUr CArD. YOUr SErvICE.
Extras! Discounts for Members
negotiated special discounts from
products and services.
Questions? We’re here to help!
Our Customer Service team is dedicated to providing you with accurate information.
Have your ID card ready and call 1-800-592-6804 between 8 a.m. – 5 p.m., Monday – Friday, Pacific Time.
014564 (12-2009)
Note about cover: The sample ID card on the cover may not match what appears on your card, as benefits differ by plan.
Please note that this booklet is not a contract. For more information about the full terms and conditions of your health plan, including benefits, limitations and exclusions, please see your Benefit Booklet.
037336 (07-2016)
Discrimination is Against the Law LifeWise Health Plan of Washington complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. LifeWise does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. LifeWise: • Provides free aids and services to people with disabilities to communicate
effectively with us, such as: • Qualified sign language interpreters • Written information in other formats (large print, audio, accessible
electronic formats, other formats) • Provides free language services to people whose primary language is not
English, such as: • Qualified interpreters • Information written in other languages
If you need these services, contact the Civil Rights Coordinator. If you believe that LifeWise has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator - Complaints and Appeals PO Box 91102, Seattle, WA 98111 Toll free 855-332-6396, Fax 425-918-5592, TTY 800-842-5357 Email AppealsDepartmentInquiries@LifeWiseHealth.com You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue SW, Room 509F, HHH Building Washington, D.C. 20201, 1-800-368-1019, 800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Getting Help in Other Languages This Notice has Important Information. This notice may have important information about your application or coverage through LifeWise Health Plan of Washington. There may be key dates in this notice. You may need to take action by certain deadlines to keep your health coverage or help with costs. You have the right to get this information and help in your language at no cost. Call 800-592-6804 (TTY: 800-842-5357). (Amharic): LifeWise Health Plan of Washington 800-592-6804 (TTY: 800-842-5357)
:(Arabic) .
LifeWise Health Plan of Washington. .
. (TTY: 800-842-5357) 6804-592-800 .
(Chinese): LifeWise Health Plan of Washington

800-592-6804 (TTY: 800-842-5357)
Oromoo (Cushite): Beeksisni kun odeeffannoo barbaachisaa qaba. Beeksisti kun sagantaa yookan karaa LifeWise Health Plan of Washington tiin tajaajila keessan ilaalchisee odeeffannoo barbaachisaa qabaachuu danda’a. Guyyaawwan murteessaa ta’an beeksisa kana keessatti ilaalaa. Tarii kaffaltiidhaan deeggaramuuf yookan tajaajila fayyaa keessaniif guyyaa dhumaa irratti wanti raawwattan jiraachuu danda’a. Kaffaltii irraa bilisa haala ta’een afaan keessaniin odeeffannoo argachuu fi deeggarsa argachuuf mirga ni qabaattu. Lakkoofsa bilbilaa 800-592-6804 (TTY: 800-842-5357) tii bilbilaa. Français (French): Cet avis a d'importantes informations. Cet avis peut avoir d'importantes informations sur votre demande ou la couverture par l'intermédiaire de LifeWise Health Plan of Washington. Le présent avis peut contenir des dates clés. Vous devrez peut-être prendre des mesures par certains délais pour maintenir votre couverture de santé ou d'aide avec les coûts. Vous avez le droit d'obtenir cette information et de l’aide dans votre langue à aucun coût. Appelez le 800-592-6804 (TTY: 800-842-5357). Kreyòl ayisyen (Creole): Avi sila a gen Enfòmasyon Enpòtan ladann. Avi sila a kapab genyen enfòmasyon enpòtan konsènan aplikasyon w lan oswa konsènan kouvèti asirans lan atravè LifeWise Health Plan of Washington. Kapab genyen dat ki enpòtan nan avi sila a. Ou ka gen pou pran kèk aksyon avan sèten dat limit pou ka kenbe kouvèti asirans sante w la oswa pou yo ka ede w avèk depans yo. Se dwa w pou resevwa enfòmasyon sa a ak asistans nan lang ou pale a, san ou pa gen pou peye pou sa. Rele nan 800-592-6804 (TTY: 800-842-5357). Deutsche (German): Diese Benachrichtigung enthält wichtige Informationen. Diese Benachrichtigung enthält unter Umständen wichtige Informationen bezüglich Ihres Antrags auf Krankenversicherungsschutz durch LifeWise Health Plan of Washington. Suchen Sie nach eventuellen wichtigen Terminen in dieser Benachrichtigung. Sie könnten bis zu bestimmten Stichtagen handeln müssen, um Ihren Krankenversicherungsschutz oder Hilfe mit den Kosten zu behalten. Sie haben das Recht, kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Rufen Sie an unter 800-592-6804 (TTY: 800-842-5357). Hmoob (Hmong): Tsab ntawv tshaj xo no muaj cov ntshiab lus tseem ceeb. Tej zaum tsab ntawv tshaj xo no muaj cov ntsiab lus tseem ceeb txog koj daim ntawv thov kev pab los yog koj qhov kev pab cuam los ntawm LifeWise Health Plan of Washington. Tej zaum muaj cov hnub tseem ceeb uas sau rau hauv daim ntawv no. Tej zaum koj kuj yuav tau ua qee yam uas peb kom koj ua tsis pub dhau cov caij nyoog uas teev tseg rau hauv daim ntawv no mas koj thiaj yuav tau txais kev pab cuam kho mob los yog kev pab them tej nqi kho mob ntawd. Koj muaj cai kom lawv muab cov ntshiab lus no uas tau muab sau ua koj hom lus pub dawb rau koj. Hu rau 800-592-6804 (TTY: 800-842-5357). Iloko (Ilocano): Daytoy a Pakdaar ket naglaon iti Napateg nga Impormasion. Daytoy a pakdaar mabalin nga adda ket naglaon iti napateg nga impormasion maipanggep iti apliksayonyo wenno coverage babaen iti LifeWise Health Plan of Washington. Daytoy ket mabalin dagiti importante a petsa iti daytoy a pakdaar. Mabalin nga adda rumbeng nga aramidenyo nga addang sakbay dagiti partikular a naituding nga aldaw tapno mapagtalinaedyo ti coverage ti salun-atyo wenno tulong kadagiti gastos. Adda karbenganyo a mangala iti daytoy nga impormasion ken tulong iti bukodyo a pagsasao nga awan ti bayadanyo. Tumawag iti numero nga 800-592-6804 (TTY: 800-842-5357). Italiano (Italian): Questo avviso contiene informazioni importanti. Questo avviso può contenere informazioni importanti sulla tua domanda o copertura attraverso LifeWise Health Plan of Washington. Potrebbero esserci date chiave in questo avviso. Potrebbe essere necessario un tuo intervento entro una scadenza determinata per consentirti di mantenere la tua copertura o sovvenzione. Hai il diritto di ottenere queste informazioni e assistenza nella tua lingua gratuitamente. Chiama 800-592-6804 (TTY: 800-842-5357).
(Japanese): LifeWise Health Plan of Washington


800-592-6804 (TTY: 800-842-5357) (Korean): . LifeWise Health Plan of Washington . . . . 800-592-6804 (TTY: 800-842-5357) .
(Lao): . LifeWise Health Plan of
Washington. . . . 800-592-6804
(TTY: 800-842-5357). (Khmer):


LifeWise Health Plan of Washington



800-592-6804 (TTY: 800-842-5357)
(Punjabi):
. LifeWise Health Plan of
Washington . .

,
, 800-592-6804 (TTY: 800-842-5357).
:(Farsi) .
. LifeWise Health Plan of Washington .
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