All CHPW Individual & Family Plans (Cascade Select Gold, Silver, and Bronze) cover the same list of medical services. The cost of deductibles, copays, and coinsurance for each service varies depending on the plan.
CHPW Individual & Family Plans are Exclusive Provider Organization (EPO) plans, which means that we cover services only when you receive them from Network Providers, with limited exceptions such as emergency care.
- Services and procedures covered
- Limitations or exclusions
- Out-of-pocket costs
- Summary of Benefits and Coverage (SBC)
- Evidence of Coverage (EOC)
Here are some select highlights of our coverage.
Coverage for provider visits applies to in-person and virtual (also known as telehealth or telemedicine) care. Medical coverage includes:
- Preventive care
- Primary care
- Specialty care
- Urgent care
- Emergency room
- Labs and X-rays
- Mental health services
- Pregnancy and newborn services
- Rehabilitation services
For a detailed list of covered medical services, please see the 2023 Evidence of Coverage.
Under the Affordable Care Act (ACA), most health plans must cover certain preventive services, such as vaccinations and screenings, with no out-of-pocket costs to you (i.e., $0 copay). For more information, see the List of Covered Preventive Services (healthcare.gov) and coverage information from the Office of the Insurance Commissioner.
To find a provider in our network, see our Find a Doctor page.
Our plans cover inpatient, residential, and outpatient medically necessary treatment of mental health and substance use disorders. This includes chemical dependency treatment for substance use disorders. You don’t need a referral to see mental health providers in our network.
See our Behavioral Health page for more details.
Routine vision services are not covered for adults. Pediatric vision services, including professional fees, supplies and materials, are covered for children under the age of 19. Covered pediatric vision services include:
- Routine vision screening
- Comprehensive eye exam
- Prescription lenses or contacts
- One pair of frames or contact lenses, once per calendar year
If your regular doctor doesn’t provide virtual visits, or if their office is closed, don’t worry. As a CHPW member, you have access to 24/7 care through CHPW Virtual Care.
With this benefit, you can visit with a doctor by phone or video at any time, day or night, without having to leave your home. See the Virtual Care page for details.
This benefit provides coverage for prescription drugs dispensed by a participating pharmacy (a pharmacy in our network). Your prescriptions are covered under our plan only if they are filled at a participating pharmacy or through our mail-order pharmacy service.
Your Prescription Drugs benefit has four tiers: Generic, Preferred Brand, Non-Preferred Brand, and Specialty. You pay a cost-share of either a copay or coinsurance for each separate new prescription or refill.
For more information, go to our Prescription Drug Coverage page.