To help manage rising health care costs, a new emergency room (ER) out-of-pocket limit was added to the Regence KingCare PPO and KingCare Select medical plans for those in the Regular and TEA-DOT employee benefit groups. If you fall into one of these groups and visit the ER, your total out-of-pocket costs may be higher this year.
Here’s what you need to know:
What’s changing?
Beginning Jan. 1, 2025, Regular and TEA-DOT employees enrolled in Regence medical plans have a separate out-of-pocket limit for ER visits. These limits are in addition to out-of-pocket limits for medical and prescription drugs. Your out-of-pocket costs for an ER visit, which include a $200 copay and 15% coinsurance, haven’t changed but those costs will now apply to a new ER out-of-pocket limit (separate from the medical out-of-pocket limit).
- KingCare PPO medical plan: The new ER out-of-pocket limit is $6,600 per individual and $12,900 per family.
- KingCare Select medical plan: The new ER out-of-pocket limit is $6,600 per individual and $13,000 per family.
Once you reach this limit, your medical plan will cover 100% of additional ER costs for the rest of the year.
Please note that your out-of-pocket costs for all other medical services will still apply to the medical out-of-pocket limits. For more information on your out-of-pocket limits, please refer to the King County Medical Plan Comparison guide.
How having a primary care provider (PCP) can help
Having a PCP may help you save money by avoiding emergency room visits. A PCP can:
- Help you manage chronic conditions, such as diabetes and heart disease, to help you stay on top of your overall health.
- Support preventive care to keep you feeling well.
- Provide expert guidance when you’re sick or injured.
- Offer walk-in, after-hours, or virtual care options to address urgent health issues without the high costs of an ER visit.
If you do not already have a PCP to help you navigate your health care needs, contact Regence at 800-376-7926, or visit this blogpost.
For more information
For more details about these changes, including a list of available alternatives to the ER, please review this document.
Questions? Contact Benefits, Payroll & Retirement Operations at 206-684-1556 or email kc.benefits@kingcounty.gov.