Understanding Your Health Plan

We encourage all patients to check with your health insurance company before making an appointment to learn about your insurance coverage, co-pay requirements and provider networks. (Be sure to note which physicians, clinics and hospitals are included in your provider network.)

Insurance can change throughout the year. Please verify that your Polyclinic physician is a participating provider with your insurance to ensure access and coverage.

  • 2018 Washington Health Benefit Exchange
  • Questions to ask for verifying coverage
  • Glossary of Health Insurance Terms
  • Insurance Plans - Updated for 2018

    Health Plan Accepted Product Type Plan Information
    Aetna Most plans accepted, including Medicare retirement and Aetna Whole Health. Aetna’s Aexel network is designated for Neurology, Plastic Surgery, and Vascular Surgery. Please know you may have higher co-pays and co-insurance if you see a non-designated provider.
    Ambetter from Coordinated Care Exchange plan. Not accepted.
    Amerigroup from Apple Health/Medicaid Limited. Some Polyclinic providers accept this plan; please check with the physician’s office.
    Anthem All plans.
    Asuris All plans. Contracted through Regence Blue Shield
    Basic Health Plan from Washington Apple Health/Medicaid Limited. Some Polyclinic providers accept these plans; please check with the physician’s office.
    BridgeSpan Exchange and non-Exchange plans. Not in network; if offered in your county some services may be available at out-of-network rates. Contact your provider’s office to confirm.
    Cigna Most plans.
    Community Health Plan of Washington, from Apple Health/Medicaid Limited. Some Polyclinic providers accept this plan; please check with the physician’s office.
    Coordinated Care from Apple Health/Medicaid Limited. Some Polyclinic providers accept this plan; please check with the physician’s office.
    Coventry Multiplan, First Health
    United Healthcare (UHC) Most plans, including Oxford Healthcare, AARP Medicare Complete, Pacificare, Secure Horizons, Medicaid/Medicare Dual Complete Community Plan
    First Choice Health Network All plans.
    First Health Plans through Coventry.
    Greatwest Healthcare Most plans. Owned by Cigna.
    Healthy Options from Washington Apple Health/Medicaid Limited. Some Polyclinic providers accept these plans; please check with the physician’s office.
    Holland America Cruise Lines n/a At this time, The Polyclinic does not accept this plan.
    Humana Most plans.
    Interplan, formerly Healthsmart Most plans.
    Kaiser Permanente Limited. Some plans are accepted without a referral. Please check with your insurance company about referrals and pre-authorizations that may be required prior to scheduling an appointment.
    Labor and Industry (L&I) Plans accepted for established patients. The Polyclinic will accept new L&I claims, including self-insured L&I carriers.
    LifeWise Exchange plan. When offered in your county (not offered in King, Pierce, or Snohomish Counties). Accepted.
    Maritime Medical Act The Polyclinic works with a number of fishing vessel companies to provide health care coverage to crewmembers covered under the Jones Act.
    Medicaid Limited. Some Polyclinic providers accept these plans; please check with your physician’s office.
    Medicare Limited. Some Polyclinic providers accept Original Medicare; please check with your physician’s office.
    Medicare Advantage Aetna Medicare Choice Plan, Aetna Medicare Select Plan, Aetna Medicare Value Plan, Aetna Medicare Platinum Plan, AARP Medicare Complete Insured through United Healthcare Plans 1, 2 and 3, Humana Choice, Humana Gold Plus, Humana Gold Plus DE-SNP, Premera BlueCross Medicare Advantage, Premera Blue Cross Medicare Advantage Classic, Premera Blue Cross Medicare Advantage Classic Plus, Regence Med Advantage + Rx Classic, Regence MedAdvantage Basic, United Healthcare Dual Complete Medicare Advantage/Medicaid Learn more about Medicare Advantage at The Polyclinic.

    This is not a complete listing of plans available in your service area. For a complete listing, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult medicare.gov.

    The Polyclinic does not accept Medicare Advantage Private Fee for Service (PFFS) plans. We do accept retirement benefit plans from state or federal governments or private employers.

    Molina Healthcare from Apple Health/Medicaid Limited. Some Polyclinic providers accept Original Medicare; please check with your physician’s office.
    Molina Marketplace n/a At this time, The Polyclinic does not accept this plan.
    Motor Vehicle Accident (MVA) The Polyclinic will establish care with new patients after a motor vehicle accident; but we do not bill automotive insurance companies, such as Geico. We will forward claims to patients; you are responsible for forwarding to your MVA insurance company. Because we are not contracted with all MVA insurance companies, you may incur some out-of-pocket expenses; please check with your MVA insurance company.
    Premera Blue Cross Most plans. Premera PersonalCare - Virginia Mason network only; accepted.
    Multiplan (Private Healthcare Systems or PHCS) Most plans.
    Providence Health Plan Most plans.
    Regence Blue Shield Most plans. Regence RealValue plan not accepted.
    Tricare Prime Standard and Extra Most plans. We are not contracted with Tricare. This may result in a higher out-of-pocket expenses. Please check directly with Tricare for cost share information.
    United Healthcare (UHC) Most plans accepted.
    Uniform Medical Plan Retirement Medicare plans, including UMP Classic and UMP Consumer-Directed Health Plan
    Uniform Services Family Health Most plans.
    Zenith Administrators Most plans accepted.


    2018 Washington Health Benefit Exchange

    Health Plan Product Type Plan Information
    Ambetter from Coordinated Care n/a Not accepted.
    BridgeSpan Not in network; if offered in your county some services may be available at out-of-network rates. Contact your provider’s office to confirm.
    Kaiser Permanente Core and Flex Accepted by Polyclinic specialty providers only. Requires a referral from your Kaiser Permanente primary care provider.
    LifeWise LifeWise Connect "Essential" Network When offered in your county (not offered in King, Pierce, or Snohomish Counties). Accepted.
    Molina n/a Not accepted.
    Premera Premera Preferred when offered to residents outside of King, Pierce and Snohomish counties. Premera PersonalCare – Virginia Mason network only; accepted.

    2017 Washington Health Benefit Exchange

    Health Plan Product Type Plan Information
    Ambetter from Coordinated Care n/a
    BridgeSpan Providence-Swedish Health Network only. Plans with networks other than Providence/Swedish; including RealValue and SimpleConnect are not accepted.
    Community HealthEssentials Community Health Plan of Washington through the First Choice Health Network
    Group Health Core and Flex Accepted by Polyclinic specialty providers only. Requires a referral from your Group Health primary care provider.
    LifeWise LifeWise Connect "Essential" Network
    Premera Premera Preferred when offered to residents outside of King, Pierce and Snohomish counties. Premera PersonalCare not accepted.
    Regence Providence-Swedish Health Alliance Network only. Plans with networks other than Providence/Swedish are not accepted.


    Questions to Ask Your Insurance Company

    • Is my Polyclinic doctor included in my insurance plan’s provider network?
    • What hospitals are included in my provider network should I ever need inpatient care?
    • What are my co-pays for primary care visits? What are my co-pays for specialist visits?
    • What preventive care services or well visits are covered on my plan?
    • Do I need a referral from my primary care doctor before seeing a specialist?
    • Do I need prior authorization from the insurance company before scheduling any diagnostic tests such as CT scans, MRI tests, etc.?
    • Do I need prior authorization from the insurance company for any medications that are prescribed for me?
    • Do I need prior authorization from the insurance company before scheduling any procedures including surgery?

    Updated: 11-17-2017