Welcome to your benefits
Healthcare is complex. We get it. Explore highlights of your new 2024 plan, based on what people use and ask about the most. If you are on a grandfathered plan, please refer to your benefit booklet.
Looking for a summary of benefits for each plan? Explore Summary of Benefits and Coverage
Choose benefit highlights
Start exploring: Staying healthy & more
Key things to know: Staying Protected
Vaccinations
- COVID-19 vaccines are free.
- Approved at-home COVID-19 test kits are free.
- Flu shots are free at any pharmacy.
- All other routine vaccines are free at in-network doctors' offices.
- Travel vaccines (like typhoid) are free at travel clinics or county health departments.
- To avoid upfront costs, be sure to see an in-network provider.
Checkups
- Annual wellness exams are free in-network.
- But if you discuss a symptom, injury, or condition, you may be charged for a regular office visit (not free).
Cancer screenings
- Routine screenings for cancer (like colonoscopies) are free in-network.
- Skin cancer screenings by an in-network dermatologist are covered, but not free.
- If your test is ordered because of a symptom or concern, it is diagnostic. It may be covered, but is not free.
- Please refer to the preventive tip sheet to confirm which screenings are covered 100% at in-network providers.
Therapy
- No referral needed.
- No visit limits.
- See qualified providers for talk therapy, or medication, or both.
- Not sure who to see? Get connected with specialists in your area or use virtual care.
Prescriptions
- Save money using generic drugs for ongoing medication.
- Some drugs require approval to be covered. To confirm, check drug coverage or call LifeWise.
- To check drug coverage:
Sign in, go to Benefits, then Prescriptions, and then click on Go to Express Scripts. - Once on Express Scripts page, select Prescriptions, then Price a Medication.
Inpatient facilities
- Checking in to round-the-clock care is covered.
- However, it's only covered for as long as it's medically necessary. After that, you pay 100%.
- Out-of-network facilities are not covered. Meaning you will pay 100% of the costs.
- Know that Emergency care, including for mental health care, is covered worldwide but usually not free. In the United States, Out-of-network ERs and certain providers cannot bill you for amounts above what LifeWise pays, meaning you're protected from balance billing.
- Call LifeWise if you want help finding an in-network facility.
Doctor or specialist visits
- No referral needed.
- No visit limits, except for spinal manipulations, acupuncture, massage, and physical therapy. Massage and physical therapy are covered under outpatient rehab, which also covers speech therapy and occupational therapy.
- Second opinions are covered.
- Visits to a doctor's office to discuss a symptom or condition are covered, but not free.
- In order to pay the lowest amount for visits with your Primary Care Provider, please be sure to see your assigned Primary Care Provider.
- Want to find an in-network provider near you? Sign in to Find a Doctor.
Virtual visits
- No visit limits.
- Virtual visits scheduled with a doctor's office are covered at the same level as in-person visits (not free).
- In-network virtual care apps are also covered, for 24/7 doctor access for things like a cold, rash, or to monitor a chronic condition.
- Get all virtual care options.
Diagnostic tests
- Sometimes doctors order x-rays, scans, or other tests to figure out what's going on with you.
- These tests are usually covered, but not free.
- Your doctor may recommend a certain lab or facility, but it's your choice where to go.
- Want help finding local, in-network facilities? Call LifeWise.
Kinwell Clinics
- Member-exclusive Kinwell clinics are located throughout Washington.
- Available for primary and behavioral healthcare.
- Explore healthcare goals and set up plans to achieve them.
- New patients are welcome at convenient appointment times.
- If you have dual health plan coverage, know that Kinwell Clinics only accept LifeWise and Premera insurance plans.
- Find a location.
Save money
- Want to see if a medication is covered, and compare local pharmacy prices?
- To price a medication:
Sign in, go to Benefits, then Prescriptions, and then click on Go to Express Scripts. - Once on Express Scripts page, select Prescriptions, then Price a Medication.
- You can fill most prescriptions at any in-network pharmacy.
- You will automatically get the lowest cash price at the pharmacy counter for your prescribed generic drugs.
Home delivery
- Getting medication mailed to you can be convenient for recurring prescriptions, as long as they're not urgent.
- If you want home delivery, you'll need a 90-day prescription, and to complete a form.
- Controlled drugs like opioids or ADHD medications aren't available through home delivery.
Birth control
- Visits to the doctor for birth control are free in-network.
- Birth control pills, patches, rings, IUDs, implants, and more are covered. Many generics are free.
- The morning-after pill is covered when prescribed by an in-network doctor.
Massage
- A doctor must prescribe massage.
- Visit limits apply.
- Visits to a licensed massage therapist are covered, but not free.
- Check your visit limits and costs. See Summary of Benefits and Coverage.
Naturopath
- No referral needed.
- No visit limits.
- Visits to a naturpathic doctor (N.D.) are covered, but not free. Vitamins, supplements, and naturopathic medication are not covered. You pay 100% of these costs.
- Prefer a naturopath near you? Sign in to Find a Doctor.
Acupuncture
- No referral needed.
- 12 visit limit per calendar year (PCY).
- Visits to a licensed acupuncturist are covered, but not free.
- See Summary of Benefits and Coverage.
Emergencies
- Emergency care is covered worldwide, but usually not free.
- Out-of-network ERs in the United States and certain providers cannot bill you for amounts above what LifeWise pays, meaning you're protected from balance billing.
- If you need emergency care, call 911.
- If you are not in an emergency, but want to locate in-network ERs, sign in to Find a Doctor, or call LifeWise.
Virtual care 24/7
- In-network virtual care apps are covered, for 24/7 doctor access for things like a cold, rash, or to monitor a chronic condition.
- You can get labs and drugs prescribed.
- Some, like Doctor On Demand, may cost less than a standard office visit.
- Browse all virtual care options or call the 24-Hour NurseLine at 800-784-9265 (free) to help decide if you need immediate care.
Urgent care
- Same-day care for medical issues that are urgent, but not life threatening, is covered, but usually not free.
- Some urgent care clinics do x-rays.
- Out-of-network urgent care is not covered, meaning you will pay 100% of the costs.
- Even urgent care attached to an in-network hospital can be out-of-network.
- Want to find in-network urgent care near you? Sign in to Find a Doctor, or call LifeWise for help.
Health and Fitness
- Keep moving with a low-cost Active&Fit Direct membership.
- Membership includes access to our network of more than 11,900 local and national fitness clubs.
- Get answers from coaches about healthy eating and nutrition.
- Access more than 9,000 digital workout videos.
- To enroll with Active&Fit Direct, sign in to your LifeWise account.
Prenatal care
- Routine prenatal care is covered in-network.
- Choose a doctor or licensed midwife - LifeWise covers both.
- Genetic testing may be covered, but needs preapproval. It's usually not free.
Giving birth
- LifeWise covers birth at a hospital, birthing center, or at home.
- Save money by picking an in-network hospital and doctor.
- Doulas are not covered.
- Your newborn will have a hospital bill of their own.
Breastfeeding
- Lactation consultants and breast pumps are free in-network.
- For in-network lactation experts and breast pump suppliers, call LifeWise.
Add newborn to your plan
- Enroll your newborn as a dependent to your plan within 60 days of birth.
- Newborn care is covered but not free.
- Your newborn must meet their own deductible.
- Many newborn visits are covered at 100% under preventive visits. Please refer to the preventive tip sheet.
Doctor or specialist visits
- No referral needed.
- No visit limits, except for spinal manipulations, acupuncture, massage, and physical therapy. Massage and physical therapy are covered under outpatient rehab, which also covers speech therapy and occupational therapy.
- Second opinions are covered.
- Visits to a doctor's office to discuss a symptom or condition are covered, but not free.
- In order to pay the lowest amount for visits with your Primary Care Provider, please be sure to see your assigned Primary Care Provider.
- Want to find an in-network provider near you? Sign in to Find a Doctor.
Virtual visits
- No visit limits.
- Virtual visits scheduled with a doctor's office are covered at the same level as in-person visits (not free).
- In-network virtual care apps are also covered, for 24/7 doctor access for things like a cold, rash, or to monitor a chronic condition.
- Get all virtual care options.
Diagnostic tests
- Sometimes doctors order x-rays, scans, or other tests to figure out what's going on with you.
- These tests are usually covered, but not free.
- Your doctor may recommend a certain lab or facility, but it's your choice where to go.
- Want help finding local, in-network facilities? Call LifeWise.
Kinwell Clinics
- Member-exclusive Kinwell clinics are located throughout Washington.
- Available for primary and behavioral healthcare.
- Explore healthcare goals and set up plans to achieve them.
- New patients are welcome at convenient appointment times.
- If you have dual health plan coverage, know that Kinwell Clinics only accept LifeWise and Premera insurance plans.
- Find a location.
Therapy
- No referral needed.
- No visit limits.
- See qualified providers for talk therapy, or medication, or both.
- Not sure who to see? Get connected with specialists in your area or use virtual care.
Prescriptions
- Save money using generic drugs for ongoing medication.
- Some drugs require approval to be covered. To confirm, check drug coverage or call LifeWise.
- To check drug coverage:
Sign in, go to Benefits, then Prescriptions, and then click on Go to Express Scripts. - Once on Express Scripts page, select Prescriptions, then Price a Medication.
Inpatient facilities
- Checking in to round-the-clock care is covered.
- However, it's only covered for as long as it's medically necessary. After that, you pay 100%.
- Out-of-network facilities are not covered. Meaning you will pay 100% of the costs.
- Know that Emergency care, including for mental health care, is covered worldwide but usually not free. In the United States, Out-of-network ERs and certain providers cannot bill you for amounts above what LifeWise pays, meaning you're protected from balance billing.
- Call LifeWise if you want help finding an in-network facility.
Lab work
- Routine bloodwork at an annual checkup is free in-network.
- Other lab work and biopsies are usually covered, but not free.
- When medically necessary, Vitamin D testing is covered, but not free.
- Please refer to the preventive tip sheet to confirm which labs are covered 100% at in-network providers.
Scans and tests
- Tests like x-ray, MRI, EEG, and colonoscopy let doctors see inside the body.
- Mammograms and colonoscopies are free in-network only if they're a screening based on age or risk.
- Tests to diagnose or monitor a chronic condition are usually covered, but not free. Some need preapproval. They can be expensive.
- Call LifeWise if you want help finding an in-network facility.
Screening or diagnostic?
- The same test - like a colonoscopy - can be either a screening (free) or diagnostic (covered, but not free). How can you tell?
- If the test is used to check out a sign, symptom, or health concern, it is diagnostic.
- Avoid surprise costs: Ask the doctor's office if a recommended test is preventive. If they say "no," then it's not free.
- Call LifeWise for help finding in-network test facilities or labs.
Any surgery
- You may get several bills from a single surgery (hospital, doctor, anesthesia).
- Cosmetic surgery is not covered.
- Planned surgery often needs preapproval. For major surgery (like spine) preapproval can take time.
- Call LifeWise if you want to check if your doctor's preferred facility is in-network.
Physical therapy
- Doctors can prescribe physical therapy for your pre-surgical treatment or post-surgery care. It's usually not free.
- Only a certain number of visits are covered. After that, you pay 100%.
- After the first 6 visits, you must get preapproval to continue to be covered for physical therapy.
- See Summary of Benefits and Coverage to check your visit limits and costs.
Home medical equipment
- Healing and recovery sometimes require a brace, toilet lift, or walker.
- If doctors prescribe medical equipment, they're often covered, but not free.
- Some items need preapproval or to be bought from a specific store.
- If you want it covered, call LifeWise before you buy.
Therapy
- No referral needed.
- No visit limits.
- See qualified providers for talk therapy, or medication, or both.
- Not sure who to see? Get connected with specialists in your area or use virtual care.
Prescriptions
- Save money using generic drugs for ongoing medication.
- Some drugs require approval to be covered. To confirm, check drug coverage or call LifeWise.
- To check drug coverage:
Sign in, go to Benefits, then Prescriptions, and then click on Go to Express Scripts. - Once on Express Scripts page, select Prescriptions, then Price a Medication.
Inpatient facilities
- Checking in to round-the-clock care is covered.
- However, it's only covered for as long as it's medically necessary. After that, you pay 100%.
- Out-of-network facilities are not covered. Meaning you will pay 100% of the costs.
- Know that Emergency care, including for mental health care, is covered worldwide but usually not free. In the United States, Out-of-network ERs and certain providers cannot bill you for amounts above what LifeWise pays, meaning you're protected from balance billing.
- Call LifeWise if you want help finding an in-network facility.
Shots and medication
- Some shots in the doctor's office to manage pain or increase mobility are covered, but not free.
- Some, like corticosteriods, need preapproval.
- Hyaluronan shots are not covered.
- You can pre-check prescription costs and coverage from local pharmacies.
- To price a medication:
Sign in, go to Benefits, then Prescriptions, and then click on Go to Express Scripts. - Once on Express Scripts page, select Prescriptions, then Price a Medication.
Physical therapy and massage
- Doctors can prescribe physical therapy for pre- or post-surgery treatment or massage as part of your care. Usually not free.
- Only a certain number of visits are covered. After that, you pay 100%.
- See Summary of Benefits and Coverage to check your visit limits and costs.
Chiropractic visits
- Doctors can prescribe chiropractic adjustments (spinal manipulation) as part of your care. Usually not free.
- Only a certain number of visits are covered. After that, you pay 100%.
- See Summary of Benefits and Coverage for your visit limits and costs.
Drugs and supplies
- Per Mandate SB 5546, the cost of insulin is capped at $35.
- Want to know costs for other drugs? To price a medication:
Sign in, go to Benefits, then Prescriptions, and then click on Go to Express Scripts. - Once on Express Scripts page, select Prescriptions, then Price a Medication.
- Buy syringes, lancets, and OneTouch® test strips at in-network pharmacies. They are covered, but not free.
Glucose meters and insulin pumps
- A OneTouch® glucose meter is covered, but not free. Order a diabetic meter.
- Insulin pumps, CGM (continuous glucose monitoring) devices, and their supplies are covered, but not free.
- Pumps and CGMs must be pre-approved if over $750. Call LifeWise before you rent or buy.
Whole-body care
- Diabetes can impact your whole body, so we cover the following in-network:
- Dietician visits (free)
- Certified diabetes classes (free)
- Orthotics (not free)
- Call LifeWise if you need more information.
Migraine drugs
- Check drug costs in advance or compare local pharmacy prices before filling prescriptions.
- To price a medication:
Sign in, go to Benefits, then Prescriptions, and then click on Go to Express Scripts. - Once on Express Scripts page, select Prescriptions, then Price a Medication.
- Drug costs and coverage can change. Some require preapproval.
- You will automatically get the lowest cash price at the pharmacy counter for your prescribed generic drugs.
Botox shots
- Botox for migraines is not free, but may be covered when:
- prescribed by a doctor
- meets the medical policy
- is preapproved by LifeWise
Doctor or specialist visits
- No referral needed.
- No visit limits, except for chiropractors and physical therapy.
- Second opinions are covered.
- Visits to a doctor's office to discuss a symptom or condition are covered, but not free.
- Want to find an in-network provider near you? Sign in to Find a Doctor.
Inhalers and drugs
- Check drug costs in advance or compare local pharmacy prices before filling prescriptions.
- To price a medication:
Sign in, go to Benefits, then Prescriptions, and then click on Go to Express Scripts. - Once on Express Scripts page, select Prescriptions, then Price a Medication.
- Drug costs and coverage can change. Some require preapproval.
- You will automatically get the lowest cash price at the pharmacy counter for your prescribed generic drugs.
Refills via virtual care
- Just need a refill? Don't want to schedule an office visit?
- Browse all virtual care options.
Testing
- Tests to confirm or monitor asthma are covered, but not free.
- For some people, allergies affect asthma.
- When medically necessary, allergy testing and shots are covered, but not free.
Doctor or specialist visits
- Repeat visits for any chronic condition - addiction, cancer, heart disease - are common.
- No referral needed.
- Second opinions are covered.
- No visit limits (except massage, physical therapy, chiropractors, acupuncture).
- Visits are covered, but not free. Sign in to Find a Doctor.
Diagnosis and monitoring
- Mammograms and colonoscopies are free in-network only for a screening based on age or risk.
- Tests (scans, labs, biopsies) to diagnose or monitor are usually covered, but not free. Some need preapproval. Can be expensive.
- Want help navigating logistics, benefits, or costs? Call LifeWise to request a free Personal Care Advisor.
Medications
- Check drug costs in advance or compare local pharmacy prices before filling prescriptions.
- To price a medication:
Sign in, go to Benefits, then Prescriptions, and then click on Go to Express Scripts. - Once on Express Scripts page, select Prescriptions, then Price a Medication.
- Drug costs and coverage can change. Some require preapproval.
- You will automatically get the lowest cash price at the pharmacy counter for your prescribed generic drugs.