Group Health plans
Founded in 1947 and based in Seattle, Group Health Cooperative is a nonprofit health care system that coordinates care and coverage. The Cooperative offers three plans — Classic, Value, and SoundChoice — while a fourth plan, the CDHP, is offered by Group Health Options, Inc., a wholly owned subsidiary of the Cooperative.
You’re eligible to enroll in a Group Health plan if you’re eligible for PEBB benefits. The SoundChoice plan, however, is only available to employees who live in King, Pierce, Snohomish, or Thurston county.
If you already know which Group Health plan you want, see enroll in a medical and dental plan to enroll. Use the information on this page for help choosing the plan that’s best for you and your family.
In general, when you have a Group Health plan, you’ll visit Group Health Medical Centers to receive care and get prescriptions. Group Health has locations throughout Puget Sound and encompasses a wide array of doctors and other professionals. However, you don’t receive coverage if you use a provider outside the plan’s network.
The exception is the consumer-directed health plan (CDHP), which has a large network that includes providers nationwide. The other plans have smaller, regional networks: the Classic and Value plans share the same network while the SoundChoice has its own, slightly smaller network.
To browse each plan’s network or to find a specific provider, either call the plan directly or use the plan’s web search tool.
|Plan||Network||Find a provider online|
|Group Health CDHP||Access PPO||CDHP network search|
|Group Health Classic||Core/Group Health||Classic plan network search|
|Group Health SoundChoice||PEBB SoundChoice||SoundChoice network search|
|Group Health Value||Core/Group Health||Value plan network search|
The four Group Health plans offer you a range of cost options. As is always the case with health insurance, it’s best to consider not only the premium but also the costs for using services, such as the deductible, coinsurance, and copayments.
Premiums and deductibles
Premium and deductible costs are the primary difference between the Classic plan and the Value plan.
While the Value plan has cheaper premiums, its deductible is higher than the Classic plan. Otherwise, they have identical networks and similar coverage costs. For example, a visit to your primary care doctor costs $15 with the Classic plan and $20 with the Value plan.
The SoundChoice plan and CDHP both offer premiums that are considerably cheaper than the Classic and Value plans.
The CDHP is a high-deductible style plan, which means that in return for taking on the financial risk of a high deductible, you pay a significantly lower premium. You also get a Health Savings Account to help pay for medical costs. Learn more about how CDHPs and HSAs work.
Copayments or coinsurance?
With coinsurance, the costs you pay for services are calculated as a percentage (for example, 20 percent). Insurance pays the remaining percentage of the cost. With copayments, on the other hand, you pay a fixed amount (for example, $20).
Generally, you’ll pay coinsurance after your visit the doctor, when the bill arrives in the mail. Copayments are usually made at the doctor’s office, when you get the service.
While plans using coinsurance are more common, some people prefer plans with copayments because costs are more predictable.
This predictability is why some people prefer the Classic and Value plans, which use copayments for services. Unlike coinsurance, where you may not know your exact cost until your bill arrives, copayments allow you to know your cost before you visit the doctor.
In contrast, the SoundChoice plan and CDHP both use coinsurance for most services. However, both offer premiums that are noticeably cheaper than both Classic and Value.
The table shows a sample of costs to help you quickly compare plans. For a full list of costs, refer to the Certificate of Coverage.
|Primary care visit
*With SoundChoice, your first primary care visit each year is free, then the cost is 20%
While all plans cover the same basic health care services, you may want to know whether or not a certain service is covered by the plan. The most direct way to find out is to call the plan and ask. Alternatively, you can read the plan’s Certificate of Coverage (also called the benefits booklet), which describes the plan in detail. These booklets are long, but they can be helpful if you need to know something specific.
If you simply want an overview of a plan’s coverage and costs, take a look at the plan Summary of Benefits and Coverage, an easy-to-read summary that lets you quickly review health plans. You can compare options based on price, benefits, and other features that may be important to you.
To view plan details side by side and directly compare coverage and costs, use the state’s medical benefit comparison tool.
|Plan||Certificate of Coverage (2016)||Summary of Benefits
and Coverage (2016)
|Group Health CDHP – Individual||View (PDF)||View (PDF)|
|Group Health CDHP – Family||View (PDF)||View (PDF)|
|Group Health Classic||View (PDF)||View (PDF)|
|Group Health SoundChoice||View (PDF)||View (PDF)|
|Group Health Value||View (PDF)||View (PDF)|
Prescription drug coverage
With Group Health, you’re required to use network pharmacies for prescription drugs; otherwise you’ll pay full price for prescriptions. There isn’t a deductible for prescriptions, and mail-order drugs are available in all plans.
All the plans use copayments, rather than coinsurance, for prescription coverage. Coverage is tiered: the amount you pay increases as you move up the tiers from the least expensive, generic drugs to the more expensive, specialty drugs.
You can find complete details about prescription drug coverage by reviewing the plan’s Certificate of Coverage.
Generally, vision benefits are part of your medical plan. Providers can be found in the provider directory, or by contacting the medical plan.