Northwest Carpenters Health and Security Plan

Preferred Provider Organization 

Previous Policy

This section describes what a preferred provider organization or PPO is and how it helps reduce your out-of-pocket expenses. This section does not apply to the plan's HMO benefit through Kaiser, or the plan's dental, vision or prescription drug benefits.

Topics Discussed in This Section

Previous Policy


The Northwest Carpenters Health and Security Plan uses a preferred provider organization (PPO) to help reduce your out-of-pocket expenses and help control plan costs. A PPO is an independent company that negotiates fees with health care providers and then offers those discounted fees to a medical plan for a fee. A PPO contracts with hospitals, physicians, clinics, chiropractors, laboratories, medical equipment suppliers, mental health agencies, and a number of other health care providers.

Previous Policy

Regence Network

Effective September 1, 2021, the plan contracted with Regence to provide a PPO network. The Board of Trustees selected Regence's Preferred Network with access to the Blue Cross Blue Shield National BlueCard network because it is a nationwide and international network that includes a wide variety of providers from all provider specialties.

Network (PPO) Services

When you use a network provider, the cost of services and supplies is discounted. The following guidelines apply:

  • You are strongly encouraged to use network physicians, urgent care centers, hospitals, and other providers. If you use a network provider, most covered medical expenses are paid at 90 percent by the plan and at 10 percent by the patient. When the patient's coinsurance reaches the $2,300 or $4,600 annual coinsurance maximums, benefits that would otherwise be paid at 90 percent are paid at 100 percent for the remainder of that calendar year.
  • You are not required to designate a primary care doctor. However, for the best quality of care, the plan encourages you and your dependents to establish an ongoing relationship with a primary care doctor.
  • You are not required to have a referral from your primary care doctor if you need to see a specialist.
  • If you use a network provider, that provider is required by contract to get approval from Regence before providing certain services. This safeguards you from incurring medical expenses that may not be covered by the plan.
  • Network providers will file your claims and accepts direct payment from the plan. Your network provider can collect the $10 office visit copayment at the time of your appointment.

Medicare-eligible retirees expenses are processed at the network level.

Non-Network (Non-PPO) Services

Although you may receive care from any licensed provider covered by this plan, using a non-network provider may result in higher out-of-pocket expenses for you and your dependents. Several examples are provided below:

  • If you use a non-network provider, most covered medical expenses are paid at 80 percent of the maximum allowable fee by the plan and at 20 percent of the maximum allowable fee by the patient. These services always require 20 percent coinsurance and these coinsurance payments do not apply toward the $2,300 or $4,600 annual coinsurance maximums.
  • The office visit copayment is $20 instead of $10.
  • The patient has a $200 copayment for inpatient facility admissions.
  • The provider may charge more for a procedure or service than the plan allows. You are responsible for the amount that exceeds the plan's maximum allowable fee.
  • The provider may require that you pay for his or her services up front.
  • The provider may not obtain the required approval for a service that requires precertification. There are penalties for failing to obtain approval on certain services. Please see Medical Review Programs for more information.
  • You may have to file a paper claim if the provider is not willing to file the claim for you.

Previous Policy

ID Cards

You will receive three ID cards when you first gain dollar bank eligibility and are enrolled in the plan. The information on these cards is used by your providers to verify eligibility with the plan and to electronically submit your claims. These ID cards are not a guarantee of ongoing eligibility. Medicare-eligible retirees receive different cards when they become eligible for Medicare as described below.

  1. Regence/Carpenters Trusts ID Card
    This ID card is for all medical services including physician, laboratory, durable medical equipment, and hospital services.
  2. Express Scripts ID Card
    This ID card is for all prescription services including retail and home delivery services.
  3. Delta Dental of Washington ID Card
    This ID card is for all dental and orthodontic services.

Medicare-Eligible Retirees

Medicare-eligible retirees receive a new Carpenters Trusts ID card for medical services and a new Express Scripts ID card for prescription drugs.

Previous Policy

Direct Billing

Network providers bill the plan directly. If your non-network provider will not bill the plan, you must submit the claim to Regence. Filing instructions are available here.

Regence BlueShield
PO Box 1106
Lewiston, Idaho 83501
Fax: (888) 606-6582


Effective October 1, 2023, Regence BlueShield provides information about preferred providers. To access preferred provider information, please access the appropriate Regence Medical Plan booklet below:

If you are covered under Kaiser, review the Kaiser plan booklet for medical benefit information.

Last Updated: 01/12/2024