No. The St. Luke’s Health Plan will utilize the St. Luke’s Health Partners provider network. St. Luke’s Health Partners is one of the largest health care provider networks in the state, and St. Luke’s providers and facilities make up only one-third of it. The other two-thirds are independent practitioners and facilities who have joined the network’s effort to increase access to health care. With thousands of providers and hundreds of locations throughout the network, members can access the highest quality of care where and when they need it. Search for in-network doctors or specialists.

St. Luke’s Health Plan will not include Medicare Advantage options at this time.

No. St. Luke’s Health Plan will only offer individual and small group plans in alignment with the federal SEP rules for enrollment outside of the Open Enrollment period.

St. Luke’s Health Plan does not currently offer a designation link. Instead, we recommend brokers work with their clients to set up designation through Your Health Idaho. This ensures brokers have full visibility into their clients’ tax credit eligibility and enrollment information.

For in-network urgent care:

• Individual Plans
• Bronze: $50, after deductible
• Bronze HSA: 50%, after deductible
• Silver – Standard: $50, no deductible
• Silver – 73% CSR: $50, no deductible
• Silver – 87% CSR: $35, no deductible
• Silver – 94% CSR: $25, no deductible
• Gold $35, no deductible
• Small Group Plans
• Small Group Silver HSA: 40%, after deductible
• Small Group Silver – Standard: $50, no deductible
• Small Group Gold: $35, no deductible

For out-of-network urgent care with all plans, benefit is 60% after out-of-network deductible.

We have access for individuals to enroll in Health Savings Accounts, Employee Assistance Programs, OnDemand Virtual Care, Lifestyle Medicine options, and more.

Review the Prescription Drug List for a full list of covered medications.

Yes. The following classes of medications do not require the member to meet their deductible before St. Luke’s Health Plan contributes to the cost of the prescription. These medications are identified within the Prescription Drug List as “PREV”:

• Asthma and COPD
• Blood thinners
• Brand contraceptives
• Cardiovascular
• Cholesterol
• Diabetes (Insulin, Non-Insulin, and Test Strips)
• Osteoporosis

Some medications do require Step Therapy, which will be identified as “ST” within the Prescription Drug List. Please call 833-975-1281 for questions about Step Therapy.

No.

Not at this time.

If the employee group is under 10 people, two plans may be offered. If the employee group is over ten people, three plans may be offered.

The St. Luke’s Health Plan network covers twenty counties in Idaho, with over 4,600 providers and specialists (many independent or private practitioners outside of the St. Luke’s system). At this time, services outside of those counties, but within seven states (Idaho, Utah, Washington, Montana, Alaska, Oregon, Wyoming, North Dakota, and South Dakota) are covered with First Choice Health but not at the same rate as services within the network area.

For services utilized or accessed outside of the seven states listed above, we also partner with out-of-state services under First Health. These, however, are not covered at the same rate, nor do they include balanced billing protection.