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Regence Valiance (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Regence Valiance (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Regence Valiance (PPO) in 2025, please refer to our full plan details page.
Regence Valiance (PPO) is a PPO plan offered by Cambia Health Solutions, Inc. available for enrollment in 2025 to people living in Select Counties in Utah. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Regence Valiance (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Regence Valiance (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Regence Valiance (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $45.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9550.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by Regence Valiance (PPO).
Additional Benefits
The Regence Valiance (PPO) plan offers a range of benefits with varying cost-sharing structures. For inpatient hospital stays, there is a copay for the first few days, and then no copay for the remainder of the stay. Outpatient services and specialist visits typically have a copay, while many preventive services, including primary care visits, have no copay. The plan also covers services such as ambulance, emergency, hearing, vision, and dental, each with specific copays, coinsurance, and limitations. Additionally, it includes coverage for home health, medical equipment, and skilled nursing facility stays, with varying cost-sharing. Other services like home infusion, dialysis, and diagnostic services are also covered, with some requiring coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Regence Valiance (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-4, and no copay for days 5-90, while Inpatient Hospital Psychiatric has the same cost-sharing structure.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $20 copay and 20% coinsurance, Observation Services with a $400 copay, Ambulatory Surgical Center (ASC) Services with a $20 copay and 20% coinsurance, Outpatient Substance Abuse Services with a $15 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Regence Valiance (PPO) plan, with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Regence Valiance (PPO) plan. Ground and Air Ambulance Services have a $275 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Regence Valiance (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $20 copay, and there is no coinsurance for either service. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have a $20 copay. Mental Health Specialty Services and Psychiatric Services have a copay of $15 for individual and group sessions. Additional Telehealth Benefits have a copay between $0 and $20. Other Health Care Professional and Opioid Treatment Program Services have a $20 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services, including Home-Based Palliative Care, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $499 and $999, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and eyeglass lenses have no copay, while contact lenses and eyeglass frames are covered with a maximum plan benefit coverage amount.
Dental Services See details
The Regence Valiance (PPO) plan covers dental services, with a $20 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments have no copay, with some limitations on the number of visits. Restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with a 50% coinsurance, while adjunctive general services, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. There is a maximum plan benefit of $1500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Regence Valiance (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and authorization is required. Prosthetic Devices and Medical Supplies also have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have a $5 copay, while Lab Services have no copay; Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Regence Valiance (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Regence Valiance (PPO) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or SET for PAD Services. The plan has a copay for Medicare-covered services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Regence Valiance (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, for days 21-42, there is a $214 copay, and for days 43-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the Regence Valiance (PPO) plan, acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-counter (OTC) items are covered with a maximum benefit of $30 every three months.
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