FCHA Provider Tool

Plan Document

Allan Bros., Inc.

A-503 - Allan Bros. COBRA

2023 Summary Plan Description [Allan Bros. Value PPO Plan] 2022 Summary Plan Description [Allan Bros. Value PPO Plan]

Bellevue Club

A3000 - Bellevue Club Active

2024 Summary Plan Description [Bellevue Club PPO Plan] 2023 Summary Plan Description [Bellevue Club PPO Plan] 2022 Summary Plan Description [Bellevue Club PPO Plan]

Brown & Haley

A8400 - Brown & Haley - MCCN

2023 Summary Plan Description [MyConnected Care Plan] 2022 Summary Plan Description [MyConnected Care Plan]

A8402 - Brown & Haley - PPO

2023 Summary Plan Description [PPO Plan] 2022 Summary Plan Description [PPO Plan]

CHPW Employee

7400 - CHPW Employee - Active

2022 Summary Plan Document [CHPW Employee - PPO Plan] 2022 Summary Plan Document [CHPW Employee - HDHP Plan] 2022 ERISA Document [CHPW Employee - PPO Plan] 2022 ERISA Document [CHPW Employee - HDHP Plan]

City of Ellensburg

1150 - City of Ellensburg - Active

2023 Summary Plan Description [Choice Plan with Vision] 2022 Summary Plan Description [Choice Plan with Vision]

Columbus Community Hospital, Inc.

A9800 - Columbus Community Hospital Active

2023 Summary Plan Description [Option C] 2023 Summary Plan Description [Option B] 2023 Summary Plan Description [Option A] 2022 Summary Plan Description [Option C] 2022 Summary Plan Description [Option B] 2022 Summary Plan Description [Option A]

Comprehensive HealthCare

208090 - Comprehensive - Active

2023 Summary Plan Description [Comprehensive Healthcare] 2022 Summary Plan Description [No Medical Coverage - CWCMH] 2022 Summary Plan Description [Comprehensive Healthcare]

Deschutes Brewery, Inc

A9520 - Bend Food & Beverage Active

2023 Summary Plan Description [Primary Plan] 2023 Summary Plan Description [HDHP Plan] 2023 Summary Plan Description [Buy Up Plan] 2022 Summary Plan Description [Primary Plan] 2022 Summary Plan Description [HDHP Plan] 2022 Summary Plan Description [Buy Up Plan]

Eagle Group

A-300 - Eagle Administrative Services

2023 Summary Plan Description [Plan B includes Vision and Dental] 2023 Summary Plan Description [Plan A includes Vision and Dental] 2022 Summary Plan Description [Plan B includes Vision and Dental] 2022 Summary Plan Description [Plan A includes Vision and Dental]

EvergreenHealth

5500 - EvergreenHealth

2023 Summary Plan Description [Health Savings Account Medical Plan] 2023 Summary Plan Description [EvergreenHealth PPO Plan] 2022 Summary Plan Description [Health Savings Account Medical Plan] 2022 Summary Plan Description [EvergreenHealth PPO Plan]

First Choice Health Self Funded

1 - FIRST CHOICE HEALTH

2023 Summary Plan Description [HDHP with Vision] 2023 Summary Plan Description [Fairway PPO with Vision] 2022 Summary Plan Description [HDHP with Vision] 2022 Summary Plan Description [Fairway PPO with Vision]

Gallatin County

A9900 - Gallatin County - Active

2023 Summary Plan Description [Health Benefit Plan] 2022 Summary Plan Description [Health Benefit Plan]

Good Shepherd Health Care System

5800 - Good Shepherd - Active

2023 Summary Plan Description [Good Shepherd PPO Plan] 2023 Summary Plan Description [Good Shepherd HDHP Plan] 2022 Summary Plan Description [Good Shepherd PPO Plan] 2022 Summary Plan Description [Good Shepherd HDHP Plan]

Great Falls Clinic, LLP

A7100 - Great Falls Clinic - Active

2022 Summary Plan Description [Great Falls Clinic PPO 4500] 2022 Summary Plan Description [Great Falls Clinic PPO 1000] 2022 Summary Plan Description [Great Falls Clinic HDHP]

A7101 - Great Falls Clinic - COBRA

2023 Summary Plan Description [Great Falls Clinic PPO 4500] 2023 Summary Plan Description [Great Falls Clinic PPO 1000] 2023 Summary Plan Description [Great Falls Clinic HDHP]

JMAC Corporate Services, LLC.

A-907 - Dakota Midstream

2023 Summary Plan Description [JMAC Corporate Services, LLC. PPO Plan] 2022 Summary Plan Description [JMAC Corporate Services, LLC. PPO Plan]

Kearney Regional Medical Center

A9700 - Kearney Regional Medical Center Active

2023 Summary Plan Description [HDH Plan] 2022 Summary Plan Description [HDH Plan]

Machinists Inc.

A8701 - Machinists, Inc COBRA

2023 Summary Plan Description [Health Care Plan] 2022 Summary Plan Description [No Medical Coverage] 2022 Summary Plan Description [Health Care Plan]

Mid Oregon Credit Union

A7700 - Mid Oregon Credit Union - Active

2023 Summary Plan Description [Central Oregon Select Plan] 2022 Summary Plan Description [Central Oregon Select Plan]

Monument Health

A-6000 - MONUMENT HEALTH INC.

2022 Summary Plan Description [Regional Health, Inc. PPO Plan] 2022 Summary Plan Description [Regional Health, Inc. HDHP Plan]

A-6001 - MONUMENT HEALTH EPO

2022 Summary Plan Description [EPO Plan]

MultiCare Health System

5200 - MultiCare Health System

2023 Summary Plan Description [Standard PPO with Vision] 2023 Summary Plan Description [High Deductible PPO with Vision] 2022 Summary Plan Description [Standard PPO with Vision] 2022 Summary Plan Description [High Deductible PPO with Vision]

5230 - MultiCare Health System - MCC

2023 Summary Plan Description [MyConnected Care with Vision] 2022 Summary Plan Description [MyConnected Care with Vision]

MultiCare Inland Northwest Region

A-9120 - MHS - Inland Northwest Region Active

2023 Summary Plan Description [Basic Plan] 2022 Summary Plan Description [Basic Plan]

A-9140 - MHS - Inland Northwest Region MCC Active

2023 Summary Plan Description [MyConnected Care INW] 2022 Summary Plan Description [MyConnected Care INW]

A-9140C - MHS - Inland Northwest Region MCC COBRA

2022 Amendment 1 [MyConnected Care INW]

NW Montana Schools Health Consortium

NMSC1 - Somers Schools

2023 Summary Plan Description [Comprehensive 1000-70-2000] 2022 Summary Plan Description [HDHP 3000-80-5000] 2022 Summary Plan Description [Comprehensive 1000-70-2000]

NMSC10 - Special Ed

2023 Summary Plan Description [Revised Plan 1000-70-3000] 2023 Summary Plan Description [HDHP 6050-100-6050] 2022 Summary Plan Description [Revised Plan 1000-70-3000] 2022 Summary Plan Description [HDHP 6050-100-6050]

NMSC11 - Big Fork Schools

2023 Summary Plan Description [HDHP 3000-80-5000] 2023 Summary Plan Description [Comprehensive 3000-70-5000] 2023 Summary Plan Description [Comprehensive 2000-70-4000]

Navos

A7602 - Navos COBRA

2022 Summary Plan Description [PPO Union Plan] 2022 Summary Plan Description [PPO Non Union Plan] 2022 Summary Plan Description [HSA Plan] 2022 Summary Plan Description [EPO Union Plan] 2022 Summary Plan Description [EPO Non Union Plan]

New Columbia Fruit Packers, LLC.

SG01000 - New Columbia Fruit Packers, LLC.

2023 Summary Plan Description [Core Plan with Vision and Guardian Dental] 2023 Summary Plan Description [Buy-up Plan with Vision and Guardian Dental] 2022 Summary Plan Description [Core Plan with Vision and Guardian Dental] 2022 Summary Plan Description [Buy-up Plan with Vision and Guardian Dental]

Olympia Orthopaedic Associates

7500 - Olympia Orthopaedic Associates - Active

2023 Summary Plan Document [Qualified HDHP] 2023 ERISA Document [Qualified HDHP] 2022 Summary Plan Document [Qualified HDHP] 2022 ERISA Document [Qualified HDHP] 2022 ERISA Document [PPO Plan]

7510 - Olympia Orthopaedic Associates - COBRA

2022 Summary Plan Description [Qualified HDHP]

Overlake Hospital Medical Center

A9600 - Overlake Active

2023 Summary Plan Description [Premium Plan] 2022 Summary Plan Description [Premium Plan]

Port of Tacoma

2200 - Port Workers Active

2023 Summary Plan Description [22 - Active/Cobra] 2022 Summary Plan Description [22 - Active/Cobra]

22C00 - Port Workers COBRA

2023 Summary Plan Description [22R - Retiree] 2023 Summary Plan Description [22R - Retiree without pharmacy]

22R00 - Port Workers Retirees

2022 Summary Plan Description [22R - Retiree] 2022 Summary Plan Description [22R - Retiree without pharmacy]

2800 - Port Patrol Active

2023 Summary Plan Description [28 - Active/Cobra] 2022 Summary Plan Description [28 - Active/Cobra]

28C00 - Port Patrol COBRA

2023 Summary Plan Description [28R - Retiree] 2023 Summary Plan Description [28R - Retiree without pharmacy]

28R00 - Port Patrol Retirees

2022 Summary Plan Description [28R - Retiree] 2022 Summary Plan Description [28R - Retiree without pharmacy]

SA00 - NW Seaport Alliance Active

2023 Summary Plan Description [NR - Active/Cobra] 2022 Summary Plan Description [NR - Active/Cobra]

SAC00 - NW Seaport Alliance COBRA

2023 Summary Plan Description [NRR - Non Rep Retiree]

SAR00 - NW Seaport Alliance Retirees

2023 Summary Plan Description [NRR - Non Rep Retiree without pharmacy] 2022 Summary Plan Description [NRR - Non Rep Retiree] 2022 Summary Plan Description [NRR - Non Rep Retiree without pharmacy]

Samaritan Healthcare

A7900 - Samaritan Healthcare - Active

2023 Summary Plan Description [Consumer Choice Plan with Vision] 2023 Summary Plan Description [Classic Plan with Vision] 2022 Summary Plan Description [Consumer Choice Plan with Vision] 2022 Summary Plan Description [Classic Plan with Vision]

St Charles Health System

A-8503 - St. Charles Bend/Sisters Union

2022 Summary Plan Description - Union [Select PPO Plan] 2022 Summary Plan Description - Union [Prime PPO Plan] 2022 Summary Plan Description - Union [CDHP Plan]

A-8504 - St. Charles Bend/Sisters Non-Union

2022 Summary Plan Description - Non-Union [Select PPO Plan] 2022 Summary Plan Description - Non-Union [Prime PPO Plan] 2022 Summary Plan Description - Non-Union [CDHP Plan]

St. Luke's Health Plan

SLIE - Individual On Exchange Active

2024 Outline of Coverage [St. Luke's Health Plan Silver] 2024 Outline of Coverage [St. Luke's Health Plan Gold] 2024 Outline of Coverage [St. Luke's Health Plan Expanded Bronze] 2024 Outline of Coverage [St. Luke's Health Plan Expanded Bronze HDHP] 2024 Outline of Coverage [St. Luke's Health Plan Expanded Bronze HDHP ZCS] 2024 Master Policy [St. Luke's Health Plan Silver] 2024 Master Policy [St. Luke's Health Plan Gold] 2024 Master Policy [St. Luke's Health Plan Expanded Bronze] 2024 Master Policy [St. Luke's Health Plan Expanded Bronze HDHP] 2024 Master Policy [St. Luke's Health Plan Expanded Bronze HDHP ZCS]

Valley Electric Company of Mount Vernon

4030 - Valley Electric Co. of Mt. Vernon Active

2023 Summary Plan Description [HDHP with Standard Dental and VSP Vision]

Virginia Mason Medical Center

7800 - Virginia Mason Active

2023 Summary Plan Description [Select Plan] 2023 Summary Plan Description [Essential Plan]

7820 - BRI Classic Active

2023 Summary Plan Description [Classic Plan]

7840 - BRI Health Savings Active

2023 Summary Plan Description [Health Savings Plan]

WWC Physicians PC

A7000 - WWC Physicians PC Active Employees

2023 Summary Plan Description [High Deductible Health Plan] 2022 Summary Plan Description [High Deductible Health Plan]

Washington Gastroenterology, PLLC

A5050 - WAGI COBRA

2022 Summary Plan Description [Washington Gastroenterology PPO Plan] 2022 Summary Plan Description [Washington Gastroenterology HDHP Plan]

A5051 - WAGI COBRA - MCC

2022 Summary Plan Description [Washington Gastroenterology MCC Plan]

Wellfound Behavioral Health Hospital

A8900 - Wellfound Behavioral Health

2023 Summary Plan Description [QHDHP Plan] 2023 Summary Plan Description [PPO2 Plan] 2023 Summary Plan Description [PPO1 Plan] 2022 Summary Plan Description [QHDHP Plan] 2022 Summary Plan Description [PPO2 Plan] 2022 Summary Plan Description [PPO1 Plan]

Yakima Valley Memorial

A-8300 - Memorial Foundation - Active

2023 Summary Plan Description [PPO Plan with Delta Dental] 2023 Summary Plan Description [HDHP with Delta Dental] 2022 Summary Plan Description - PPO [PPO Plan with Delta Dental] 2022 Summary Plan Description - HDHP [HDHP with Delta Dental]