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Medical Care and Plan Providers

Paying for Covered Services - 2008

Enhanced Plan

To be a member of Essence you must continue to pay your Medicare Part B premium.

How much is your monthly plan premium and how do you pay it?

In Essence Enhanced for King County, you must pay a $98 premium each month. In Essence Enhanced for Snohomish County, you must pay a $93 premium each month. Essence Enhanced offers the following three payment methods for paying your monthly plan premiums. If you are interested in any of these methods, you must indicate it on your enrollment form or contact Member Services.

  1. If you choose the direct bill method, you will be sent an invoice on or about the 15th of the month. Payment of that invoice is due by the last day of the month for your coverage starting the first day of the following month.
  2. If you choose the premium without method, the Social Security Administration will withhold the premium from your check on a monthly basis.
  3. If you choose to pay by credit card or electronic funds transfer, your premium will be charged or transferred on or about the first of the month for coverage that month.

If you have any questions about your plan premiums or the payment programs, please call Customer Service at the numbers shown below.

Standard and Enhanced Plans

What are "deductibles", "co-payments" and "co-insurance"?

A "co-payment" is a payment you make for your share of the cost of certain covered services you receive. A co-payment is a set amount per service (such as paying $5.00 for a primary care doctor visit). You pay it when you get the service.

"Co-insurance" is a payment you make for your share of the cost of certain covered services you receive. Co-insurance is a percentage of the cost of the service (such as paying 20% for durable medical equipment). You pay your co-insurance when you get the service.

What is the most you will pay for covered care?

There is a limit to how much you will have to pay each year:

You must pay the full cost of services that are not covered.

You are personally responsible to pay for care and services that are not covered by Essence. With few exceptions, you must pay for services you receive from providers who are not part of Essence unless Essence has approved these services in advance. The exceptions are care for a medical emergency, urgently needed care, out-of-area renal (kidney) dialysis services, and services that are found upon appeal to be services that we should have paid or covered.

For covered services that have a benefit limitation, you must pay the full cost of any services you get after you have used up your benefit for that type of covered service. You can call Customer Services when you want to know how much of your benefit limit you have already used.

Please keep us up-to-date on any other health insurance coverage you have.

If you have other health insurance coverage besides Essence, it is important to use this other coverage in combination with your coverage as a member to pay for the care you receive. This is called "coordination of benefits" because it involves coordinating all of the health benefits that are available to you. Using all of the coverage you have helps keep the cost of health care more affordable for everyone.

You must tell us if you have any other health insurance coverage besides Essence, and let us know whenever there are any changes in your additional insurance coverage.