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Regence Valiance (PPO)

H4605 - 001 - 0
4 out of 5 stars (4 / 5)

Regence Valiance (PPO) is a Medicare Advantage Plan by Regence BlueCross BlueShield of Utah.

This page features plan details for 2025 Regence Valiance (PPO) H4605 – 001 – 0 available in Select Counties in Utah.

Locations

Regence Valiance (PPO) is offered in the following locations.

Box Elder County, Utah
Cache County, Utah
Davis County, Utah

Click to see more locations

Plan Overview

Regence Valiance (PPO) offers the following coverage and cost-sharing.

Insurer:Regence BlueCross BlueShield of Utah
Health Plan Deductible:$0
MOOP:$9,550 In and Out-of-network
$4,500 In-network
Drugs Covered:No

Ready to sign up for Regence Valiance (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Regence Valiance (PPO) qualifies for a monthly Medicare Give Back Benefit of $45.00.

Premium Reduction:$45.00

Premium Breakdown

Regence Valiance (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$185.00 $0.00 $45.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Regence Valiance (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: Yes, contact plan for further details

Comprehensive Dental

  • Endodontics
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 50% Coins – No Copay
  • Oral and Maxillofacial Surgery
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 50% Coins – No Copay
  • Periodontics
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 50% Coins – No Copay
  • Prosthodontics, removable
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 50% Coins – No Copay
  • Restorative Services
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 50% Coins – No Copay

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: 50% Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: 50% Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: 50% Coins – No Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: 50% Coins – No Copay
  • Other Preventive Dental Services
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: 50% Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: 50% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-300 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $5 copay (Authorization Required)
  • Lab services
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0-5 copay (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
  • Specialist
    • In-Network: $20 copay per visit
  • Primary
    • Out-of-Network: 50% coinsurance per visit
  • Specialist
    • Out-of-Network: 50% coinsurance per visit

Emergency care/Urgent care

  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $20 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $20 copay
    • Out-of-Network: 50% coinsurance
  • Routine foot care
    • Not covered

Ground ambulance

    • In-Network: $275 copay
    • Out-of-Network: $275 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • Out-of-Network: $0 copay
  • Hearing aids
    • In-Network: $499-999 copay (Limits Apply)
    • Out-of-Network: $499-999 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • In-Network: $20 copay
    • Out-of-Network: 50% coinsurance
  • Fitting/evaluation
    • In-Network: $0 copay

Inpatient hospital coverage

    • In-Network: $295 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
    • Out-of-Network: 50% per day for days 1 and beyond (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $9,550 In and Out-of-network
      $4,500 In-network

Medical equipment/supplies

  • Diabetes supplies
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 50% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit
    • In-Network: $15 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $15 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • Out-of-Network: 50% per day for days 1 through 190 (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $15 copay (Authorization Required)
  • Outpatient individual therapy visit
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $295 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $15 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 50% coinsurance (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: 50% coinsurance per visit (Authorization Required)
    • In-Network: $20 copay or 20% coinsurance per visit (Authorization Required)

Preventive care

    • Out-of-Network: 50% coinsurance
    • In-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $20 copay (Authorization Required)
  • Occupational therapy visit
    • In-Network: $20 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 50% coinsurance (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: 50% per day for days 1 through 100 (Authorization Required)
    • In-Network: $10 per day for days 1 through 20
      $214 per day for days 21 through 42
      $0 per day for days 43 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 50% coinsurance (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Not covered
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Eyeglass frames
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for Regence Valiance (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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