Lifewise

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.

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

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.
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